Deescalation of axillary radiotherapy – is now the time to start?

Indication for radiotherapy of regional lymph nodes in patients with breast cancer is based on the clinical stage of the disease, surgical procedure, intraoperative and pathohistological report.It is supported by a meta-analysis of randomized clinical trials with long follow-up.However, many of these trials were performed decades ago, and, in the meantime, tremendous progress has been made in diagnostics, understanding of tumor biology, tailoring and effectiveness of systemic treatment, and technical possibilities of radiotherapy.Based on these new data, the approach to the axillary radiotherapy should be tailored, and a subset of patients in which de-escalation of axillary treatment is feasible defined.