Trial reportThe New England journal of medicine2025
Omitting Regional Nodal Irradiation after Response to Neoadjuvant Chemotherapy.
Trial report in The New England journal of medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 69 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Randomized Phase III Clinical Trial Evaluating Post-Mastectomy Chestwall and Regional Nodal XRT and Post-Lumpectomy Regional Nodal XRT in Patients With Positive Axillary Nodes Before Neoadjuvant Chemotherapy Who Convert to Pathologically Negative Axillary Nodes After Neoadjuvant Chemotherapy
DEMAND - A Phase II Trial of De-Escalation of Axillary Management in Advanced Nodal Disease
Who cites it
69 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- DEGRO practical guidelines: radiotherapy of breast cancer-regional nodal irradiation.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2026Guideline
- Ultrasound-based predictive models for response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis.BMC cancer · 2026Pooled it
- Oncologic Outcomes of Sentinel Lymph Node Biopsy Versus Targeted Axillary Dissection for Node-Positive Breast Cancer Patients After Neoadjuvant Chemotherapy: A Systematic Review and Meta-Analysis.Annals of surgical oncology · 2026Pooled it
- Guidance for Canadian Breast Cancer Practice: National Consensus Recommendations for the Systemic Treatment of Patients with HR+/HER2- Early Breast Cancer 2025.Current oncology (Toronto, Ont.) · 2026Guideline
- Prospective Clinical Trial on Expanding the Eligibility Criteria for Targeted Axillary Dissection after Neoadjuvant Systemic Therapy in Breast Cancers with Advanced Nodal Disease.Annals of surgical oncology · 2026Trial
- Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.The New England journal of medicine · 2025Trial
- Twenty-year results of the randomized European Organization for Research and Treatment of Cancer trial 22922/10925 evaluating internal mammary chain and medial supraclavicular lymph node irradiation in stage I-III breast cancer.CA: a cancer journal for cliniciansTrial
- Axillary treatment options in clinically nodes-positive breast cancer whose nodes become pathologically nodes-negative after neoadjuvant chemotherapy: a pairwise and network meta-analysis.Annals of medicine · 2026Article
- Author's reply to Rao et al.-"DEGRO practical guidelines: radiotherapy of breast cancer-regional nodal irradiation".Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2026Article
- Lack of Utility of Ki-67 in Axillary Surgical Planning and Prognostication after Neoadjuvant Chemotherapy for Node-Positive Breast Cancer.Annals of surgical oncology · 2026Article
- Expanding Eligibility for Targeted Axillary Dissection.Annals of surgical oncology · 2026Article
- Trends in Breast and Axillary Operations in Young Patients with Operable Breast Cancer from the National Cancer Database (NCDB): De-escalation of Axillary Surgery and Increased Use of Radiation.Annals of surgical oncology · 2026Article
- Optimizing axillary surgery for patients with clinically node-negative and node-positive breast cancer.Surgery today · 2026Review
- Is It Time to Redefine Clinical Nodal Staging for Breast Cancer?Annals of surgical oncology · 2026Article
- Review
- Article
- Challenges and opportunities in combining radiotherapy and immunotherapy for localized pancreatic cancer.Nature reviews. Gastroenterology & hepatology · 2026Review
- Feasibility of omitting regional nodal irradiation in cT1-2N1 breast cancer with ypN1 disease after neoadjuvant chemotherapy (KROG 21-06).Clinical and translational radiation oncology · 2026Article
- Prognostic impact of radiotherapy dose to the axilla in cN + /ypN0 breast cancer after primary systemic therapy and sentinel lymph node biopsy: toward true de-escalation of axillary management.Breast cancer (Tokyo, Japan) · 2026Article
- Comparison of ultrasound visibility and retrieval success of two ultrasound-visible clips in targeted axillary dissection after neoadjuvant chemotherapy.Breast cancer (Tokyo, Japan) · 2026Article
9 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
Authors and funding
28 authors.
Funding
Abstract
backgroundThe benefit of regional nodal irradiation in the treatment of breast cancer is well established for patients with pathologically positive axillary nodes, but whether it is also beneficial for patients whose nodes become pathologically tumor free (ypN0) after neoadjuvant chemotherapy remains unclear.
methodsWe evaluated whether regional nodal irradiation improves outcomes in patients with biopsy-proven, node-positive breast cancer who reach ypN0 status after neoadjuvant chemotherapy. Patients with breast cancer with a clinical stage of T1 to T3 (tumor size, ≤2 cm to >5 cm), N1, and M0 (indicating spread to one to three axillary lymph nodes but no distant metastasis) who had ypN0 status after neoadjuvant chemotherapy were randomly assigned to receive regional nodal irradiation or no regional nodal irradiation. The primary end point was the interval of freedom from invasive breast cancer recurrence or death from breast cancer (invasive breast cancer recurrence-free interval). Secondary end points included the locoregional recurrence-free interval, the distant recurrence-free interval, disease-free survival, and overall survival. Safety was also assessed.
resultsA total of 1641 patients were enrolled in the trial; 1556 were included in the primary-event analysis: 772 in the irradiation group and 784 in the no-irradiation group. After a median follow-up of 59.5 months, 109 primary end-point events (50 in the irradiation group and 59 in the no-irradiation group) had occurred. Regional nodal irradiation did not significantly increase the invasive breast cancer recurrence-free interval (hazard ratio, 0.88; 95% confidence interval, 0.60 to 1.28; P = 0.51). Point estimates of survival free from the primary end-point events were 92.7% in the irradiation group and 91.8% in the no-irradiation group. Regional nodal irradiation did not increase the locoregional recurrence-free interval, the distant recurrence-free interval, disease-free survival, or overall survival. No deaths related to the protocol-specified therapy were reported, and no unexpected adverse events were observed. Grade 4 adverse events occurred in 0.5% of patients in the irradiation group and 0.1% of those in the no-irradiation group.
conclusionsThe addition of adjuvant regional nodal irradiation did not decrease the risk of invasive breast cancer recurrence or death from breast cancer in patients who had negative axillary nodes after neoadjuvant chemotherapy. (Funded by the National Institutes of Health; NSABP B-51-Radiation Therapy Oncology Group 1304 ClinicalTrials.gov number, NCT01872975.).
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.