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We retrospectively analyzed a cohort of node-positive BC patients who received adjuvant radiotherapy (RT) with a volume de-escalation at the level of axillary nodes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Material and methods<\/jats:title>\n            <jats:p>We conducted a retrospective analysis of node-positive BC patients treated with adjuvant RT administered following a conventional fractionation schedule using a 3D-conformal technique to the chest wall or breast and only the IV axillary level. The primary endpoint of the study was disease free survival (DFS). Secondary endpoints included loco-regional control (LRC), and Overall Survival (OS). Toxicity was documented according to the Radiation Therapy Oncology Group (RTOG) criteria.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total cohort of 343 patients was analyzed. Loco-regional recurrence occurred in 100 (29.1%). The 5- and 10-year Kaplan-Meyer curves for DFS were 81.4% (95% CI: 79.3%\u201383.5%) and 60.9% (95% CI: 57.6%\u201364.5%), respectively. Multivariate Cox analysis confirmed that lymph node ratio (HR\u2009=\u20099.76, 95% CI: 3.12\u201330.53, p\u2009=\u20090.0001), Luminal B subtype (HR\u2009=\u20092.03, 95% CI: 1.26\u20133.29, p\u2009=\u20090.004), and triple-negative subtype (HR\u2009=\u20092.70, 95% CI: 1.22\u20135.99, p\u2009=\u20090.01) were significant predictors of poor DFS. Lymphedema in the ipsilateral arm was reported in 32 (9.3%) patients, primarily Grade 1 or 2.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Improved patients\u2019 selection and a broader use of systemic therapy could make de-escalation a feasible option. However, this approach should be avoided in patients with extensive nodal involvement, specific molecular subtypes, or comorbidities that prevent the use of chemotherapy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10549-025-07652-3","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T08:11:01Z","timestamp":1740384661000},"page":"375-384","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term outcomes of volume de-escalation for breast nodal irradiation"],"prefix":"10.1007","volume":"211","author":[{"given":"Riccardo Ray","family":"Colciago","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Ferrario","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Chissotti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Rossano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"De Sanctis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria","family":"Faccenda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denis","family":"Panizza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Trivellato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Arcangeli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,24]]},"reference":[{"issue":"6","key":"7652_CR1","doi-asserted-by":"publisher","first-page":"565","DOI":"10.21147\/j.issn.1000-9604.2023.06.02","volume":"35","author":"H Xu","year":"2023","unstructured":"Xu H, Xu B (2023) Breast cancer: epidemiology, risk factors and screening. 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