In the post-mastectomy setting, are there situations where only the regional nodes or targeted nodal basis are covered?

Thanks for asking this question. People occasionally ask this.

1. Essentially all of the trials that show a survival advantage with PMRT used comprehensive local-regional therapy. So, doing something other than both the chest wall and nodes would not be based on the available data.
2. Cancer is sneaky, insidious, and extends where we cannot see. I am not sure that I am smart enough to know "where" the cancer will recur. Indeed, historically the chest wall was one of the more common sites of local-regional failure, even with small primaries.
3. A mastectomy is not an amputation. The skin flaps used to close the mastectomy wound are essentially un-resected skin that is/was overlying (residual) breast tissue. In other words, I think the margins are n...

In the AMAROS study, they did allow regional nodal RT without treating the chest wall for a situation like this. In practice, I have avoided this unless morbidity is high like impact on reconstruction or it is in a reradiation setting.

Born too late to explore the earth, born too early to explore the stars, burn just in time to use 2024 technology to deliver treatment based on 1994-quality data.

Laying aside the "ECE" issue for a second, I think these are reasonable questions to ask in the era of modern systemic therapy. I think it is important to recognize the paradox of a woman with a small primary and 1-2 nodes who has breast conservation is eligible for "high tangents", but if the same exact woman gets a mastectomy, she gets "full-boat PMRT"?

We are likely to see (and have seen) clinical trials designed to eliminate radiation altogether rather than an elegant "full-boat PMRT" vs. "nodal only" RCT. And such an RCT tends not to give you the granular answer you want anyw...