In light of the NSABP B-51 data presented at SABCS, will you defer RNI in all patients with negative nodes after chemotherapy?  

Results of the NSABP B-51 trial were presented at the 2023 San Antonio Breast Cancer Symposium (Mamounas et al., abstract GS-02-07). This trial was designed to test the value of postoperative radiation therapy in patients who presented with clinical T1-3N1 tumors with biopsy-proven axillary node inv...

B51 has the potential to be a practice-changing trial! I agree with much of what Dr. @Recht writes in his thoughtful summary and commentary.To briefly summarize eligibility, the trial enrolled women with clinically node-positive disease (cT1-3 N1), who received NAC and had a pathologic complete...

For stage II patients with pCR in the node, I recommended pMRT or RNI specifically for triple-negative cases. In stage III (T3N1) scenarios with pCR, I recommend pMRT or RNI to all patients. Given this data, I'll need to reassess the standard treatment for these two subsets. It's worth noting that ...

Dr. @Recht's and @Gerber's write-ups above are noteworthy and thoughtful. As Dr. @Gerber notes, the majority of patients here (80%) had pathCR in the breast and nodes, suggesting that practitioners were preferentially enrolling patients they felt were at very low risk of RT omission. The inclusion o...