I come to this question with a somewhat different stance than we have traditionally thought. To me, the following things seem clear:1) In our modern randomized trials of PMRT (British Columbia and Danish 82b and c) there was no difference in the OS advantage of RT based on # of positive nodes (1-3 v...

@Jonathan B. Strauss has nicely laid out the data and the logic for treatment of women with 1-3 positive nodes post-mastectomy. To add some additional nuance, consider why the cut-off was ever historically made between 3 and 4 positive nodes. It really is somewhat arbitrary, based on crossing some o...

The data supporting the role of PMRT was obtained largely in patients with positive nodes; including any number of positive nodes (i.e., including those with 1-3 positive nodes). Overall, PMRT increases the overall survival (OS) by an absolute approximately 8-9% (range 6-12 in the various studies; e...

The absolute benefit seen in the EBCTCG for this subset is much higher than what we would expect with RT in the modern era after modern systemic therapy, which reduces the absolute risk of recurrence more than the CMF-based chemotherapy used in the analysis. That being said, the benefit of regional ...

The lack of overall survival benefit for patients who undergo RNI and the minimal, ~2% improvement in regional control with RNI demonstrated at 10 yr F/U in the MA.20 and the EORTC 22922 trials should cause us to pause when we consider RNI for patients with low volume nodal mets. I'm not sure the s...

A lot of the answers given have discussed MA.20 and EORTC 22922. I'm not sure those trials are entirely germane to the original question here. Those are important studies, but they ask questions akin to "how much to treat" in intact breast and a limited cohort of mastectomy patients. You've already ...

These comments are wonderful. A question - what is our target? Is it the chest wall, and what part of the chest wall (this leads to the issue of skin and bolus)? Which nodes? An old Veronesi study of biopsies of the IM nodes found the tumor location did not impact the risk of a positive IM node as ...