By Neena Bhandari

Sydney, 14.08.2025 (Oncology Republic): Is regional nodal irradiation beneficial for women with initially node-positive breast cancer who achieve pathologic nodal clearance (ypN0) after neoadjuvant chemotherapy? The jury is still out.

A landmark phase III study (NRG-NSABP B-51/RTOG 1304) published in the New England Journal of Medicine addressed whether adding RNI benefits women with initially node-positive breast cancer who achieve ypN0 after neoadjuvant chemotherapy.

After a median follow-up of 59.5 months, the addition of RNI did not significantly improve invasive recurrence-free survival or any secondary outcomes (HR 0.88; 95% CI 0.60–1.28; P = 0.51), and both arms had excellent IBCRFI (92.7% with RNI v/s 91.8% without RNI). Dr David Blakey, radiation oncologist at the ICON Cancer Centre in Mornington, said the results of the study had the potential to significantly alter radiotherapy recommendations after neoadjuvant systemic therapy for women achieving a complete response in the axillary nodes.

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