LAUSR

Subsequent of the publication of MA 20, EORTC 22922/10925 rials as well as DBCG IMN trial, together with series of metanalyses, the recommendation of regional nodal irradiation in node ositive breast cancer has been updated. However, during a recent nternational meeting of radiation oncology, one of the senior radition oncologists who chaired the session on breast cancer did ot seem to accept the updated international guidelines, saying hat “the radiotherapy of internal mammary nodes is a kind of eheating the cold dish, which might bring more business interst than academic importance”. We decided not to give the name f the person and conference for deontological reasons. But we ecided to give our opinion publicly and share it with the internaional community of radiation oncologists who prefer to consider hat irradiation of internal mammary nodes is the state of the art Fig. 1). And our opinion is solid, because it is associated to the solid ata of meta-analyses, randomized studies, as well as large retospective studies that show that there is a benefice in terms of urvival [1–3]; there is also a benefice in terms of locoregional conrol [1–6]; there is a decreasing of metastatic rate too. These results re given in more than 10,000 cases and we continue to discuss hether irradiation of regional lymph nodes is pertinent for breast ancer treatment. The argument against radiotherapy of internal mammary nodes s cardiac toxicity [7]; but here we also have data that cardiac toxcity is a multifactorial process and only a small part is directly ssociated to radiotherapy [8]. We also have shown that with the se of recent radiation therapy techniques, there is no increased ardiac toxicity in the long-term [4]. Other arguments to safely propose radiotherapy are recent dvances in radiation therapy techniques with sparing of organs t risk using highly performing techniques [9] and in this field adiotherapy is really transformed in state of the art (Fig. 1). It was also shown that radiotherapy can be realized in associaion with new targeted treatments without increased toxicity if the dequate technique is used [10–12]. We engaged this discussion during the meeting and we hope hat in the next years we can use biological predictors to idenify the population of patients who will be best candidates for his irradiation. In the mean time we prefer to think about irra-