{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T22:24:37Z","timestamp":1780352677057,"version":"3.54.1"},"reference-count":79,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Postmastectomy radiation Therapy (PMRT) reduces locoregional recurrence (LRR) and breast cancer mortality in patients with \u22654 positive lymph nodes. However, evidence supporting PMRT in patients with 1\u20133 positive nodes remains limited. While the 2014 Early Breast Cancer Trialists' Collaborative Group (EBCTCG) meta-analysis demonstrated benefit in this population, the constituent trials preceded current standard practices including sentinel lymph node biopsy, contemporary systemic therapies, and modern radiation therapy techniques.<\/jats:p>\n                  <jats:p>This analysis examines the applicability of EBCTCG findings to current clinical practice. Historical trials reported elevated LRR rates, potentially attributable to inadequate axillary staging and suboptimal systemic therapy regimens such as cyclophosphamide, methotrexate, and fluorouracil. Contemporary studies demonstrate substantially lower LRR rates in comparable patients managed without PMRT, particularly those with favorable tumor characteristics. Current adjuvant therapies\u2014including anthracyclines, taxanes, trastuzumab, endocrine agents, and targeted therapies such as abemaciclib and olaparib\u2014have markedly reduced recurrence risk. Retrospective analyses yield conflicting results regarding PMRT efficacy, while randomized trials (SUPREMO, TAILOR RT) seek to refine treatment indications.<\/jats:p>\n                  <jats:p>Contemporary practice should not universally recommend PMRT for intermediate-risk patients (1\u20133 nodes); instead, individualized risk assessment is warranted. The role of PMRT remains undefined in patients without axillary lymph node dissection or those achieving pathologic complete response following neoadjuvant therapy. Clinical decision-making must consider treatment benefits relative to potential late toxicities and reconstructive complications. Personalized, evidence-based approaches informed by emerging trial data represent the optimal strategy for patient management.<\/jats:p>","DOI":"10.1093\/jjco\/hyaf153","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T12:05:27Z","timestamp":1759925127000},"page":"5-11","source":"Crossref","is-referenced-by-count":1,"title":["Individualized risk stratification for postmastectomy radiation therapy in node-positive breast cancer: moving beyond universal guidelines"],"prefix":"10.1093","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3006-0648","authenticated-orcid":false,"given":"Akimitsu","family":"Yamada","sequence":"first","affiliation":[{"name":"Department of Breast Surgery, Yokohama City University Hospital , 3-9 Fukuura, Kanazawa-ward, Yokohama, Kanagawa 236-0004 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazutaka","family":"Narui","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, Yokohama City University Medical Center , 4-57 Urafunecho, Minami-ward, Yokohama, Kanagawa 232-0024 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Breast Oncology, Tokyo Medical University hospital , 6-1-1 Sinjuku, Shinjuku-ward, Tokyo 160-8402 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3202-2752","authenticated-orcid":false,"given":"Itaru","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Yokohama City University School of Medicine Graduate School of Medicine , 3-9 Fukuura, Kanazawa-ward, Yokohama, Kanagawa 236-0004 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