Abstract
We have known for around three decades that breast radiotherapy not only reduces the risk of local relapse, but also breast cancer death,1,2 albeit potentially causing major cardiac events many years later.3 The balance of benefit versus harm is particularly relevant for internal mammary node radiotherapy, where patients are usually at greater risk of relapse by virtue of having higher stage disease, but heart doses can be higher due to the close proximity of the internal mammary chain. Uncertainties around the therapeutic ratio prompted clinical trials testing regional nodal (including internal mammary node) radiotherapy, with three studies reporting in 2015.
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