Dr. Woodward on Regional Node Irradiation in Breast Cancer

Wendy A. Woodward, MD, PhD, professor and chief, Clinical Breast Radiotherapy Service, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, discusses regional nodal irradiation for the treatment of patients with breast cancer.

In the 15-year follow-up of the randomized EORTC 22922 trial of patients with node-positive stage I to III breast cancer, mortality was improved 3.8% in those who received regional nodal irradiation. One of the big challenges with regional nodal irradiation is its risk of an increased dose to the heart, but this study did not show worse cardiac outcomes. This expectation has led investigators to look at technologies to reduce heart doses. Woodward says that this concern has also led to the question of whether everyone who was eligible should receive regional nodal irradiation.

Forty percent of patients in EORTC 22922 had no positive lymph nodes, as it was a trial that largely predated sentinel lymph node biopsies. The effort now, Woodward says, is trying to determine who has enough risk of distant recurrence or overall recurrence to benefit from the treatment. Woodward says in her practice, they do not offer regional nodal irradiation to every patient who is node negative. Rather, they look at individual risk factors and offer it to people who have reasonable risk and might benefit.