Internal review.

Here is a review of outcomes for 117 women with breast cancer with upfront gross ipsilateral internal mammary node (IMN) involvement treated at MDACC between 2014-2019. They all received neoadjuvant chemo followed by surgery of the primary tumor with full axillary dissection followed by adjuvant comprehensive nodal irradiation including a boost of 10 Gy to clinically resolved IMNS or 16 Gy to persistently enlarged IMNs. So was this sufficient? We’d say so as IMN control at 5 years was 98%, though recurrence-free survival (RFS) was only 67%—with virtually all recurrences including distant mets—and overall survival was 74%. The biggest predictors of better RFS were a complete clinical response of IMNs (HR 0.24) and complete path response of dissected nodes (HR 0.27), while the biggest portenders of worse RFS were lymphovascular invasion (HR 2.25) and, interestingly, extranodal extension (HR 4.13). | Andring, Int J Radiat Oncol Biol Phys 2022