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Regional Nodal Irradiation Considerations in Patients Receiving Neoadjuvant Systemic Therapy

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Management of the Breast and Axilla in the Neoadjuvant Setting

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Abstract

Numerous randomized clinical trials and meta-analyses have demonstrated that delivery of radiation therapy to the breast/chest wall and regional lymph nodes following surgery and adjuvant chemotherapy improves local-regional control and reduces distant metastasis and breast cancer mortality for many patients with metastases to one or more axillary lymph nodes. In contrast, there remain no randomized data regarding the use of regional lymph node irradiation in patients that receive neoadjuvant systemic therapy followed by breast surgery. This has led to controversy regarding which patients with breast cancer will benefit from regional lymph node irradiation after neoadjuvant systemic therapy (NST), especially in patients with clinically node-positive axillary disease that responds well and downstages to pathologically node-negative disease at surgery (ypN0). We review the current evidence on this topic, which forms the underlying basis for two National Clinical Trial Network phase III clinical trials. NRG Oncology National Surgical Adjuvant Breast and Bowel Project (NSABP) B51/Radiation Therapy Oncology Group (RTOG) 1304 is examining the role of regional nodal irradiation in patients with clinical N1 disease that converts to ypN0 after NST, and the ALLIANCE A011202 is evaluating if nodal radiation therapy alone without axillary dissection is sufficient for when node positive breast cancer is identified after NST on sentinel node biopsy.

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Authors and Affiliations

  1. Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Solove Research Institute, Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA

    Jose G. Bazan & Julia R. White

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  1. Jose G. Bazan
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  2. Julia R. White
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Correspondence to Jose G. Bazan .

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Editors and Affiliations

  1. Breast Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Atilla Soran

  2. Dana-Farber Harvard Cancer Centar, Brigham and Women’s Hospital, Boston, MA, USA

    Faina Nakhlis

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Bazan, J.G., White, J.R. (2022). Regional Nodal Irradiation Considerations in Patients Receiving Neoadjuvant Systemic Therapy. In: Soran, A., Nakhlis, F. (eds) Management of the Breast and Axilla in the Neoadjuvant Setting. Springer, Cham. https://doi.org/10.1007/978-3-030-88020-0_12

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  • DOI: https://doi.org/10.1007/978-3-030-88020-0_12

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