Elective regional nodal irradiation in patients with early-stage breast cancer

Elective regional lymph nodal irradiation is controversial in patients with early stage breast cancer. Under the "Halstedian" model of tumor progression, elective nodal irradiation would be expected to provide some gain in both regional control and survival. Nevertheless, the data are inconclusive. When the axillary nodes are positive, there is uncertainty regarding the utility of elective irradiation of the supraclavicular and internal mammary areas. Similarly, in patients with a clinically negative axilla, the role of elective irradiation of the axilla and other nodal sites is also controversial. This article reviews data from trials that address the utility of elective regional nodal treatment, with regard to both tumor control (local control and survival) and morbidity.