Regional Nodal Radiotherapy in Early-Stage Breast Cancer: Where Are We in 2016?

The goal of locoregional treatment in early-stage breast cancer patients is to eradicate residual locoregional microscopic disease in order to maximize locoregional control, to minimize seeding of distant metastatic sites, and ultimately to improve overall survival. Recently published landmark randomized trials demonstrate that the addition of regional nodal radiotherapy to breast conserving therapy or mastectomy in node positive or high-risk node negative women not only improves locoregional control but also decreases distant metastasis with a trend towards improved overall survival with a favorable toxicity profile. Certain node-positive early-stage breast cancer patients, however, have low rates of axillary recurrence and high rates of breast cancer-specific survival even with sentinel lymph node excision alone without axillary lymph node dissection. Herein, we review the recent developments in regional nodal management and reconcile the apparent conflict between the surgical and radiotherapy literature. In this context, we provide guidance as to the patients appropriate for regional nodal radiotherapy in 2016 and highlight important treatment considerations to minimize long-term toxicity.