Should irradiation replace dissection for patients with breast cancer with clinically negative axillary lymph nodes?

AxD must be performed if the exact number of positive axillary nodes must be known for patients with early-stage invasive breast cancer. However, for patients with clinically negative axillary nodes, achieving axillary tumor control can be accomplished in several other ways. Patients with a negative SNB treated with BrRT alone are likely to have a very low risk of axillary failure. At present, further specific treatment of the axilla is generally indicated in patients with a positive SNB. Either completion AxD or AxRT is likely to be effective in preventing recurrence in this setting. Further work is needed to delineate which patients with a positive SNB could be adequately treated with BrRT alone. AxRT is also a reasonable alternative to AxD in obtaining axillary control in clinically node-negative patients if the pathologic findings in the axilla are not used to make decisions regarding systemic therapy. BrRT is an intriguing approach for selected patients in this setting but should only be performed in well designed prospective studies.