CancerBiolMed2023.doi:10.20892/j.issn.2095-3941.2022.0625EDITORIALOptimizationofregionalnodalirradiationintheeraofsentinellymphnodebiopsyZhaoBi1,Xue’erWang2,PengfeiQiu1,PengChen1,YongshengWang11ShandongCancerHospitalandInstitute,ShandongFirstMedicalUniversityandShandongAcademyofMedicalSciences,Jinan250017,China;2TianjinMedicalUniversityCancerInstitute&Hospital,NationalClinicalResearchCenterforCancer,KeyLaboratoryofCancerPreventionandTherapy,Tianjin,Tianjin’sClinicalResearchCenterforCancer,Tianjin300060,ChinaHistorically,axillarylymphnodedissection(ALND)wasthestandardmanagementforaxillarysentinellymphnode(SLN)-positivepatients,becauseitenablesfullassessmentofoverallaxillarylymphnode(ALN)metastasisstatusandfavorablelocal-regionalcontrol1,2.Strikingly,nodifferencesinaxillaryregionalrecurrenceoroverallsurvival(OS)havebeenobservedwithversuswithoutALNDamongpatientswithearlybreastcancerwithlimitedSLNinvolvementinseveralrandomized,controlledtrials,includingtheACSOGZ0011andAMAROStrial3,4.Intheeraofsentinellymphnodebiopsy(SLNB),SLNBhasreplacedALNDasthestandardapproachforpatientswith1or2positiveSLNs5.Thesechangesinclin-icalpracticeshouldbeconsideredfortheoptimizationofregionalnodalirradiation(RNI)fields.“Intelligentde-escalation”irradiationstrategyintheeraofSLNBIntheeraofSLNB,thebenefitsofsystemictherapyandradi-ationtherapycanbecombinedtonarrowthescopeofsur-geryanddecreasecomplications,thusultimatelyachievinganetbenefitwithbreastcancertreatment.Postmastectomyradiotherapy(PMRT)orRNIhasadvantagesofavoidingALND,butexposespatientstopotentiallyacuteorlong-termtoxiccomplications(includingrarebutpotentiallyfatalsec-ondcancersandcardiacevents)6.DecisionsregardingthechoiceofALNDandradiotherapymustbemadebyamulti-disciplinaryteam.TheMemorialSloanKetteringCancerCenter7hasproposedan“intelligentde-escalation”strat-egyinwhichthenumbersoflymphnodemetastasesandriskfactorsareusedtodeterminewhetherpatientsshouldreceivePMRTorRNI.Theriskfactorsincludeprimaryfac-tors[age<40years,triplenega...
