In light of the NSABP B-51 data presented at SABCS, will you defer RNI in all patients with negative nodes after chemotherapy?

Results of the NSABP B-51 trial were presented at the 2023 San Antonio Breast Cancer Symposium (Mamounas et al., abstract GS-02-07). This trial was designed to test the value of postoperative radiation therapy in patients who presented with clinical T1-3N1 tumors with biopsy-proven axillary node inv...

B51 has the potential to be a practice-changing trial! I agree with much of what Dr. @Dr. First Last writes in his thoughtful summary and commentary.

To briefly summarize eligibility, the trial enrolled women with clinically node-positive disease (cT1-3 N1), who received NAC and had a pathologic comp...

Dr. @Dr. First Last's and @Dr. First Last's write-ups above are noteworthy and thoughtful. As Dr. @Dr. First Last notes, the majority of patients here (80%) had pathCR in the breast and nodes, suggesting that practitioners were preferentially enrolling patients they felt were at very low risk of RT ...

For stage II patients with pCR in the node, I recommended pMRT or RNI specifically for triple-negative cases. In stage III (T3N1) scenarios with pCR, I recommend pMRT or RNI to all patients. Given this data, I'll need to reassess the standard treatment for these two subsets.

It's worth noting that t...