BIG deal.

A woman with T1-2 breast cancer with 1-3 positive lymph nodes is possibly the most controversial patient in all of breast cancer. Does she need an axillary dissection? Post-mastectomy radiation (PMRT)? Regional nodal radiation?? The 2008 BIG 02-98 was a randomized trial of adjuvant anthracycline-based chemotherapy +/- a taxane, with a side note of PMRT (majority comprising tangents and supraclavicular field) being allowed per institutional preference. A new subset analysis of patients with T1-2 disease and 1-3 positive nodes post-axillary dissection demonstrates a significant decrease in locoregional recurrence (LRR) at 10 years in those who got PMRT (6.5→ 2.5%), though this didn’t translate into improved breast cancer specific survival. What's more, this improvement was mainly seen in those who didn’t receive a taxane. TBL: An unplanned subgroup analysis reports utterly unsurprising data that PMRT improves LRR in women with 1-3 positive lymph nodes, with a survival benefit determined by baseline risk.