In which patients receiving regional nodal irradiation do you include the internal mammary nodes?

I think the study adds to the body of literature supporting regional nodal irradiation as contributing to survival, breast cancer mortality and disease free survival in high risk breast cancer. This study suggests that there is an incremental benefit associated with inclusion of the internal mammary nodes and it does influence my practice in being more pro-active in treating the internal mammary nodes in patients at risk, provided it can be accomplished respecting cardiac and pulmonary dose constraints-which it usually can. For a more extensive discussion please see the associated editorial in JCO authored by Haffty, Whelan and Poortmans (JCO/11/30/2015-ePUB).