In a patient with ypN+ breast cancer with an adequately dissected axilla, do you omit radiation to the dissected axilla when treating the regional nodes?

I usually omit radiating adequately dissected axilla even in ypN+. Exceptions may include macroscopic ENE (>2mm), extra-nodal infiltration of tumor cells, surgeon's concern about disease clearance (usually matted nodes etc so that's also ENE), large number of nodes positive (I usually consider for N...

Yes, we usually omit radiation to dissected axilla, especially if the patient had an anatomic dissection (rather than just a sampling) per the OP report.

We consider RT to dissected axilla if residual nodal burden is very high (we use 50% as a cut-off) or if there is persistent ECE (definitely for g...

Great question; ideally this patient should be enrolled on the ongoing Alliance trial which is stratifying patients to nodal RT vs ALND in patients who have a residual positive node after neoadjuvant chemo. Pending the much anticipated results of this study there is some data to consider in favor of...