Would you ever recommend PMRT to the chest wall alone without nodal radiation for invasive or in situ breast disease?  

In patients who are node negative upfront, I do offer PMRT for adverse primary tumor  factors  which meets criteria for PMRT to CW only. Retrospective data suggest majority of local recurrence in CW in these pts and can skip RNI

One of the most striking findings of the NCIC CTG MA.20 and EORTC 22922/10925 studies was that the addition of RNI provided a greater absolute reduction in distant recurrence than isolated locoregional recurrence. Similarly we know from multiple prior patterns of failure studies that the risk of iso...

- I do not know of any indication for RNI in In-Situ Breast cancer( Included in Question) -In regard to Invasive breast cancer, I agree with Sushil about no benefit to RNI in Node negative cases( Dissection or Reliable SLN BX) when we radiate the Chest wall for adverse primary Tumor factors.

Agree with above:   1. In-Situ disease- can consider chest wall PMRT without RNI for positive margins only 2. Invasive disease- I routinely treat RNI with chest wall RT for all cases with the exception of T1-2N0 with positive margins. For T3N0 cases, I usually include RNI as the added morbid...