Tailoring of Radiation After NACT

Numerous randomized clinical trials and meta-analyses have established the beneficial impact of post-mastectomy radiation therapy (PMRT) on locoregional control and survival in patients of axillary node-positive breast cancer undergoing upfront surgery. However, the role of PMRT in the setting of neoadjuvant chemotherapy (NAC) followed by mastectomy remains a grey area to date. This has sparked active research into identifying the cohort of patients who would benefit from PMRT after NAC, especially in the scenario where clinically axillary node-positive disease (cN+) has downstaged to pathologically node-negative disease post-surgery (ypN0). The results from two Phase III trials, namely the National Surgical Adjuvant Breast and Bowel Project (NSABP) B51/RTOG 1304 and the Alliance A11202, are particularly awaited concerning the role of regional nodal irradiation (RNI) in such patients.