Is it ever appropriate to de-escalate regional nodal coverage in PMRT for patients with localized inflammatory breast cancer (IBC)?   

Historically, IBC is traditionally treated with trimodality therapy to include PMRT with comprehensive regional nodal irradiation (RNI). However, given increasing interests in treatment de-escalation of carefully selected patients throughout various disease sites, including IBC (Fayanju et al. 2020), are there any IBC patients for which you would consider omitting full/partial nodal coverage?

Do you comprehensively cover all nodal basins (i.e. dissected+undissected axilla, SCV, IMN) regardless? What factors, if any, would influence you to deviate from this paradigm? Hormone-receptor/Her2 status? Presence of residual primary tumor? Patient-related factors for high lymphedema risk (i.e. obesity, # LNs removed, wound issues, poorly controlled DM, etc)?