biostudies-literatureKunkler IHMedical Research Council1771-1783https://www.ebi.ac.uk/biostudies/studies/S-EPMC7618363biostudies-literatureUnknown393(18)<h4>Background</h4>The role of postmastectomy chest-wall irradiation in patients with breast cancer classified as pN1 (with involvement of one to three axillary nodes) or pN0 (pathologically node negative) with additional risk factors is uncertain.<h4>Methods</h4>In this international, phase 3, randomized trial, we evaluated the omission of chest-wall irradiation in women with "intermediate-risk" breast cancer - defined as cancer that was stage pT1N1, pT2N1, or pT3N0 or stage pT2N0 with a histologic grade of 3, lymphovascular invasion, or both (tumor size: T1, ≤2 cm; T2, >2 cm to 5 cm; or T3, >5 cm) - that was treated with mastectomy, an axillary procedure, and systemic therapy. Patients were assigned to undergo chest-wall irradiation (40 to 50 Gy; the irradiation group) or not to undergo The New England journal of medicineTen-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.PMC7618363G0400170 grant ID 69733G0400170Velikova GSUPREMO Trial InvestigatorsHatcher OShah NSyndikus IWright KBartlett JMSRobson PSadler GWhipp EAnandadas CBedi CJyothirmayi RRitchie DHurkmans CRolles MEvan RMaclennan MSimmonds PRiddle Kvan Tienhoven GGaffney CBundred NBahl AMcCormick GSham SYDown SDhadda AKendall AWelch RChittalia AMahtab NWilliams LJStorey NDeSilva-Minor SNeal ALawless SHatton MLawton PRussell NSMcLennan MMcCarty HLocke ILee DWoodings PO'Toole LWestwell SKelly CSainsbury RMacdonald EBarthakur UGhosal NStockdale AHall AEichholz ABishop JBrunt AChaudhuri AHicks JHignett SRoe HTaylor KJWolstenholme VGeropantas KLumsden GBarraclough LBlackman GClarke JBrunt MSergenson NMichalakis IRoberts NUpadhyay SVarughese MSampson KGoodman ABrown AWells TSunilWalji NThomas JSChakrabarti AHaritakis MNamini SThompson EKumar SThorp NEvans RWang SFraser JMasinghe SAlhasso AGriffin MPersic MHogg MDunlop JVaidya JSherwin LHanby AMSoe WMacGregor CSharma RChurn MHennessy AMisra VBranson TLi YDunn GJones JFernando ICrellin PMcEleney THamilton CBrazil LBayman NCanney PBowen JIqbal NJohnson KDixon JMLoncaster JDanwata FWestenberg HQuigley MCameron DAtkinson CBeresford MMukesh MBMithal NForrest JBarrett-Lee PThandar HWilliamson DMagee BKunkler IHVerghese ETLewanski CCleator SHadaki MRaj SVenables KPiper TMarshall JChapman HMilanovic DGrieve RHarris SRiddle PBliss PMuturi FYuille FAllerton RGahir DBurns JLim CSripadam RAnderson NKhan MStevens AChua BBrown JAird ELupton SSkailes GNeedleman SMalik ZfalseTen-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.<h4>Background</h4>The role of postmastectomy chest-wall irradiation in patients with breast cancer classified as pN1 (with involvement of one to three axillary nodes) or pN0 (pathologically node negative) with additional risk factors is uncertain.<h4>Methods</h4>In this international, phase 3, randomized trial, we evaluated the omission of chest-wall irradiation in women with "intermediate-risk" breast cancer - defined as cancer that was stage pT1N1, pT2N1, or pT3N0 or stage pT2N0 with a histologic grade of 3, lymphovascular invasion, or both (tumor size: T1, ≤2 cm; T2, >2 cm to 5 cm; or T3, >5 cm) - that was treated with mastectomy, an axillary procedure, and systemic therapy. Patients were assigned to undergo chest-wall irradiation (40 to 50 Gy; the irradiation group) or not to undergo 2025-01-01T00:00:00Z2025 Nov2026-06-05T16:36:24.67Z2026-05-18T03:13:21.387ZS-EPMC76183634119193910.1056/NEJMoa2412225