When treating breast cancer patients with RNI, how often do you include internal mammary nodes?

Treating the internal mammary nodes (IMNs) increases heart and lung exposure; hence, the value of prophylactic IMN RT has been controversial for decades. Randomized trials suggest there may be some benefit to such treatment but disagree on which patient subgroups benefit most or not at all.

A trial c...

We try to include for all but the threshold for under coverage or to skip IM coverage is low if dosimetric constraints are harder to meet, especially for 1 to 3 nodes and outer quadrant disease.

I wrote in this forum in September 2023 about the uncertain value of internal mammary node (IMN) irradiation based on 4 large randomized trials and a nonrandomized Danish experience that allocated patients with right-sided cancers (but not those with left-sided ones) to IMN irradiation. The EORTC pu...