03/08/2025
🧠 Radiotherapy Decision-Making: Still an Art as Much as a Science
We’re proud to share a newly published international consensus article in Radiotherapy & Oncology—featuring our Head of Department Duvern Ramiah- on one of the most debated areas in breast cancer treatment: regional nodal irradiation (RNI) after a positive sentinel lymph node biopsy.
Titled “What guides regional nodal irradiation in node-positive breast cancer following upfront sentinel lymph node biopsy?”, the paper brings together leading experts from around the world to evaluate how radiation oncologists decide whether—and how—to treat the axilla with radiotherapy. The findings reveal a striking truth: even among global experts, consensus is elusive. For many patients, especially those with intermediate-risk disease, treatment approaches vary widely depending on the clinician’s interpretation of multiple clinical factors.
This variability underscores an important point: radiotherapy decision-making is incredibly nuanced, and guidelines often leave room for interpretation. It is precisely why continued research, like that conducted at Wits Radiation Oncology, is essential—to refine our understanding, reduce uncertainty, and ultimately improve outcomes for our patients.
We are proud to see our department contributing to work of global relevance, and we remain committed to leading evidence-based, patient-centered cancer care in South Africa and beyond.
Due to many randomised studies investigating different risk factors that do not always coincide, breast cancer experts rely on a wide variety of criteria to recommend RNI for pN1(sn) breast cancer, leading to heterogeneity in decision-making. With this work we aim to raise awareness of this challeng...