Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The long-awaited B51 has been published. A study that opens door, but doesn’t close them all. Should we irradiate nodal areas in cN1 patients who achieve ypN0 after NAC?
  • Evidence might be solid to omit RNI in HER2+ patients with good response. This group appears to be the most promising.
  • The triple-negative cohort shows a puzzling signal: higher risk with irradiation. Statistical noise? Selection bias? Serendipity?
  • In pure luminal cases—5% in practice but only 20% in the trial there’s a trend toward benefit with RNI.
  • Limited follow-up, low representation, and no data on grade or LVI make it hard to change practice based on this evidence.
  • Also, I wonder if this was actually two studies in one:
    • In mastectomy, it’s all or nothing—irradiate everything or nothing at all.
    • In breast-conserving surgery, it’s about adding or omitting RNI from standard treatment.
  • B51 is a step toward personalized treatment but not the final word.
  • Sometimes, less is not less—but more.
  • Yet omission must always be thoughtful.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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