The use of surgery and radiotherapy as treatment of regional nodes in breast cancer patients

Ipsilateral regional nodal status is an important independent prognostic factor for patients with breast cancer. Several decisions regarding local therapy are necessary for patients found to have pathologically involved lymph node(s). This article reviews the role of completion dissection and/or radiation therapy in patients found to have positive sentinel lymph node(s), taking into consideration use of mastectomy vs lumpectomy, tumor characteristics, tumor biology, plans for systemic therapy, and patient preferences. Published literature and current guidelines are reviewed, with emphasis on controversial topics such as regional nodal and postmastectomy radiation therapy for patients with one to three positive nodes. Choice of field design in patients undergoing radiation therapy will also be highlighted. Unique clinical situations such as locoregional treatment in patients receiving neoadjuvant chemotherapy and the emerging role of tumor biology and molecular assays in local therapy decision making will also be discussed.