Rigor Reviewed

Rigor-Reviewed Manuscript

Omitting Regional Nodal Irradiation after Response to Neoadjuvant Chemotherapy

Name: Adcurare Rigor Record — Omitting Regional Nodal Irradiation after Response to Neoadjuvant Chemotherapy
Item: Omitting Regional Nodal Irradiation after Response to Neoadjuvant Chemotherapy
Rating: 59
Author: Adcurare

Mamounas EP, Bandos H, White JR, Julian TB, Khan AJ, Shaitelman SF, Torres MA, Vicini FA, Ganz PA, McCloskey SA, Lucas PC, Gupta N, Li XA, McCormick B, Smith B, Tendulkar RD, Kavadi VS, Matsumoto K, Seaward SA, Irvin WJ, Lin JY, Mutter RW, Muanza TM, Stromberg J, Jagsi R, Weiss AC, Curran WJ, Wolmark N.

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Adcurare Rigor Review — 2.5★ (Weak), 0 critical, 6 high issues for “Omitting Regional Nodal Irradiation after Response to Neoadjuvant Chemotherapy”

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This rigor review was examined and confirmed by Adcurare Editorial · July 16, 2026

Adcurare Rigor Review

Rigor Reviewed

2.5 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern−0.5★
ClaimsUnsupported claim (uncorroborated)−0.5★
ReportingKey resources not met−0.5★
ReportingData & code availability not met−0.5★
ReportingBiological variables partially met−0.25★
ReportingEthical approvals partially met−0.25★

Model-reported confidence: moderateReviewer agreement: moderateEngine: 7.7.0Source: full text

Problems surfaced6 types

Conclusions not supported by the paper’s own evidence
Data and code not shared
Key resources not identified
Biological variables underreported (sex, age, strain)
Ethics/consent reporting incomplete
Internal contradictions in the reported numbers

This Adcurare Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This phase 3 RCT is well-grounded scientifically and transparently reported, with a clear rationale and appropriate conclusions. However, it has several critical reporting gaps: a demonstrable numerical inconsistency (1,802 vs. 1,602) in the overall survival denominator, missing sex and health-status demographics for participants, no data availability statement, and unidentified key resources (radiation equipment, statistical software). These issues undermine the paper's robustness and would warrant a correction or independent re-analysis.

All 8 dimensions were applicable. The three reviewers agreed on 5 dimensions, diverged somewhat on study design and biological variables, and sharply diverged on key resources (one reviewer incorrectly scored it as not applicable). The statistics verification recomputed only 1 test (consistent); the remaining analyses are not machine-verified. No retracted or missing references were found.

12 major claims checked against the paper's own evidence: 1 not fully backed by the presented evidence (unsupported or overstated).

Recomputed 1 test: 1 consistent, 0 inconsistent, 1 via agent-written checks.

1 integrity concern flagged (0 high).

Reporting

Eight Dimensions4 pass · 2 warn · 2 fail

The introduction cites multiple prior trials demonstrating benefit of regional nodal irradiation in upfront surgery patients (refs 1-5) and retrospective analyses (B-18, B-27) showing ypN0 after neoadjuvant chemotherapy predicts better outcomes, creating uncertainty. The premise that no prospective data exist for RNI in this population is clear. Limitations of prior retrospective data are acknowledged (e.g., lack of prospective data). The study objectives follow logically from the cited evidence.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The paper clearly establishes the scientific foundation by citing prior trials and retrospective analyses, providing a logical rationale for the study, and acknowledging limitations of prior work.

Evidence

paraphrase[Introduction, paragraphs 1-3]

“The introduction references trials showing RNI benefit in upfront surgery (refs 1-5) and retrospective analyses (B-18, B-27) showing improved outcomes with ypN0, but notes no prospective data exist.”

direct quote[Introduction, last sentence]

“We conducted the NSABP B-51/RTOG 1304 trial to evaluate whether regional nodal irradiation would significantly improve the interval of freedom from recurrence of invasive breast cancer in patients with clinically node-positive breast cancer whose nodes reached ypN0 status after neoadjuvant chemotherapy.”

direct quote[Introduction]

“Retrospective studies have shown that patients with clinically positive axillary nodes whose nodes convert to ypN0 after neoadjuvant chemotherapy have better outcomes compared to those whose nodes remain pathologically node-positive, creating uncertainty regarding the need for regional nodal irradiation.”

PASSReviewer 2· 90% conf

The paper clearly establishes its scientific foundation by citing prior work on regional nodal irradiation benefits in node-positive breast cancer, acknowledges the uncertainty in the neoadjuvant setting, and describes limitations of prior retrospective studies.

Evidence

paraphrase[Introduction, paragraph 1]

“The introduction cites multiple references [–] showing that adjuvant regional nodal irradiation reduces locoregional recurrence, distant recurrence, and death from breast cancer in patients with pathologically involved axillary lymph nodes who undergo surgery first.”

direct quote[Introduction, paragraph 4]

“For such patients, no prospective outcome data show benefit from regional nodal irradiation.”

direct quote[Introduction, paragraph 3]

“Retrospective studies have shown... creating uncertainty regarding the need for regional nodal irradiation.”

PASSReviewer 3· 95% conf

The paper clearly establishes its scientific foundation by citing prior work on regional nodal irradiation, neoadjuvant chemotherapy, and retrospective analyses, and provides a logical rationale for the trial.

Evidence

direct quote[Introduction, paragraph 1]

“Adjuvant regional nodal irradiation has been shown to reduce the risk of locoregional recurrence, distant recurrence, and death from breast cancer among patients with early-stage breast cancer who undergo surgery first and have pathologically involved axillary lymph nodes.”

direct quote[Introduction, paragraph 5]

direct quote[Introduction, paragraph 4]

The trial is adequately designed with pre-specified eligibility criteria, stratification factors, and a formal power analysis. The randomization method is described as 'randomly assigned' after stratification, but no details on the method (e.g., computer-generated, permuted blocks) are provided. Blinding is not mentioned; for an open-label trial, a rationale should be stated. The primary analysis is intent-to-treat, and the analysis population is clearly defined. The power analysis states 80% power to detect a 35% reduction in hazard rate, with planned accrual and event-driven analysis.

Sub-criteria

controlsN/A

power analysisADEQUATE

blinding levelsNOT REPORTED

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodINADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 85% conf

The study design is well-described for a phase 3 RCT, but the randomization method is not specified (only 'randomly assigned'), blinding is not addressed, and the analysis population deviates from strict ITT without pre-specification in the text.

Evidence

direct quote[Methods, Trial Design and Eligibility]

“Eligible patients were stratified according to the type of surgery ... and then randomly assigned to undergo regional nodal irradiation or ...”

absence[Methods, entire section]

Blinding not mentioned.

direct quote[Methods, Statistical Analysis]

“The trial was designed to have 80% power to test the hypothesis that treatment with regional nodal irradiation would reduce the annual hazard rate of invasive breast cancer recurrence-free interval events by 35%.”

PASSReviewer 2· 75% conf

The study design is rigorous for a phase 3 randomized trial, with a pre-specified power analysis, eligibility criteria, and ITT analysis. However, the randomization method is not fully described and blinding is not addressed.

Evidence

direct quote[Methods, Trial Design and Eligibility]

“Eligible patients were stratified ... and then randomly assigned to undergo regional nodal irradiation or to omit regional nodal irradiation.”

absence[Methods]

Blinding is not addressed in the manuscript.

direct quote[Methods, Statistical Analysis]

PASSReviewer 3· 85% conf

The study design is adequate for a phase 3 RCT, with clear eligibility criteria, power analysis, stratification, and ITT analysis, but the randomization method is not detailed and blinding is not addressed.

Evidence

direct quote[Methods, Trial Design and Eligibility]

“Eligible patients were stratified according to the type of surgery...and then randomly assigned to undergo regional nodal irradiation or to omit regional nodal irradiation.”

direct quote[Methods, Statistical Analysis]

absence[Methods]

Blinding is not mentioned.

For human interventional studies, the applicable sub-criteria are sex_reported, age_weight_health, and demographics. Sex is not reported in the baseline characteristics table (Table 1), which is a significant omission for a breast cancer trial. Age is reported, but weight and health status are not mentioned. Demographics (race, ethnicity) are adequately reported. The absence of sex reporting is a notable gap, leading to a 'warn' status.

Sub-criteria

demographicsADEQUATE

sex reportedNOT REPORTED

sex justifiedN/A

age weight healthINADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

FAILReviewer 1· 90% conf

The paper does not report the sex of participants (assumed female but not stated), and age/weight/health status is partially reported (age only, no weight or general health), and demographics lack sex, making reporting inadequate.

Evidence

absence[Table 1 and Methods]

Sex of participants not reported.

direct quote[Results, Patient and Treatment Characteristics]

“Median age was 52 years (IQR 44–60) with 40% being <50 years;”

direct quote[Table 1]

“Race ... Black/African American: 139 (17%) ... White: 569 (69%)”

WARNReviewer 2· 85% conf

The paper adequately reports demographics (age, race, ethnicity) but fails to report the sex of participants, which is a critical biological variable in breast cancer. Age is reported but weight/health status are not provided.

Evidence

absence[Table 1]

Sex of participants is not reported in the baseline characteristics table.

direct quote[Table 1 and Results]

“Median age was 52 years (IQR 44–60) with 40% being <50 years; 17% were Black/African American, and 14% were of Hispanic/Latino ethnicity.”

direct quote[Table 1]

“Race: Asian 8%, Black/African American 17%, White 69%, Other/Unknown 6%”

WARNReviewer 3· 80% conf

Sex of participants is not reported, and weight/health status are not reported; age and demographics (race, ethnicity) are reported.

Evidence

absence[Table 1 and Methods]

Sex is not reported.

direct quote[Results, Patient and Treatment Characteristics]

“Median age was 52 years (IQR 44–60) with 40% being <50 years; 17% were Black/African American, and 14% were of Hispanic/Latino ethnicity.”

direct quote[Table 1]

“Race: Asian 8%, Black/African American 17%, White 69%, Other/Unknown 6%; Ethnicity: Hispanic or Latino 14%.”

The paper states that the protocol was approved by the Institutional Review Board or NCI Central IRB, and written informed consent was required. However, it does not mention adherence to the Declaration of Helsinki, ICH-GCP, or the Common Rule, which is a standard requirement for human subjects research. This is a minor omission.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceNOT REPORTED

Per reviewer (3) — the votes behind the verdict

WARNReviewer 1· 90% conf

Ethics approval by IRBs and written informed consent are reported, but regulatory compliance (e.g., Declaration of Helsinki) is not explicitly stated, resulting in one inadequate sub-criterion.

Evidence

direct quote[Methods, Trial Design and Eligibility]

“The protocol was approved by either the Institutional Review Board at each participating institution or by the NCI Central Institutional Review Board.”

direct quote[Methods, Trial Design and Eligibility]

“Written informed consent was required for enrollment.”

absence[Methods and Discussion]

Regulatory compliance not explicitly stated.

WARNReviewer 2· 90% conf

The paper states IRB approval at participating institutions or the NCI Central IRB, and written informed consent was obtained. However, it does not explicitly state compliance with a recognized regulatory framework such as the Declaration of Helsinki.

Evidence

direct quote[Methods, Trial Design and Eligibility]

“The protocol was approved by either the Institutional Review Board at each participating institution or by the NCI Central Institutional Review Board.”

direct quote[Methods, Trial Design and Eligibility]

“Written informed consent was required for enrollment.”

absence[Methods]

No explicit statement of compliance with a regulatory framework is found.

WARNReviewer 3· 95% conf

The paper reports IRB approval and informed consent, but does not explicitly state compliance with a recognized regulatory framework such as the Declaration of Helsinki.

Evidence

direct quote[Methods, Trial Design and Eligibility]

“The protocol was approved by either the Institutional Review Board at each participating institution or by the NCI Central Institutional Review Board.”

direct quote[Methods, Trial Design and Eligibility]

“Written informed consent was required for enrollment.”

absence[Methods]

Regulatory compliance is not mentioned.

The paper describes the radiation therapy regimen in detail (50 Gy in 25 fractions, CT simulation, 3D conformal or IMRT) but does not specify the manufacturer or model of the linear accelerator or the treatment planning software. Software tools are not identified with version numbers. According to the scoring criteria, the investigational product and software are scored as 'reported_but_inadequate' for both applicable sub-criteria, resulting in 0% adequate and a fail.

Sub-criteria

mycoplasma testingN/A

reagents identifiedINADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedINADEQUATE

Per reviewer (3) — the votes behind the verdict

FAILReviewer 1· 85% conf

The investigational product (radiation therapy) is described but not identified with manufacturer or source, and no statistical software is named, leaving all applicable sub-criteria inadequate.

Evidence

direct quote[Methods, Radiation Therapy Regimens]

“Patients assigned to receive regional nodal irradiation received 50 Gy in 25 fractions delivered to the retained portion of level I to III axillary nodes ... with three-dimensional conformal or intensity-modulated radiation therapy.”

absence[Methods, Statistical Analysis]

Statistical software not identified.

N/AReviewer 2· 95% conf

The study is a clinical trial of a radiotherapy procedure; it does not use any key biological or chemical resources (drugs, antibodies, cell lines, etc.) that require identification per the checklist. The radiation therapy is a procedure, not a reagent, and no investigational drug or device is involved.

Evidence

absence[Entire manuscript]

No key biological or chemical resources are used in this study.

FAILReviewer 3· 90% conf

The investigational product (radiation therapy) is described in terms of dose and technique, but the manufacturer/source of the equipment and software are not identified, making replication difficult.

Evidence

direct quote[Methods, Radiation Therapy Regimens]

“Patients assigned to receive regional nodal irradiation received 50 Gy in 25 fractions delivered to the retained portion of level I to III axillary nodes...and were treated with the use of three-dimensional conformal or intensity-modulated radiation therapy.”

absence[Methods, Radiation Therapy Regimens]

Software tools (e.g., treatment planning system) are not identified by name or version.

The paper names the log-rank test and Cox proportional hazards model, tests the proportional hazards assumption, reports exact p-values and HR with 95% CIs, and presents data with Kaplan-Meier curves and tables. The per-group n's are stated. The only omission is the statistical software used (e.g., SAS, R). The mathematical plausibility of the reported numbers is acceptable; no discrepancies were found. All applicable sub-criteria except software_identified are adequate, giving 6/7 = 86% adequate, which is a pass.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedNOT REPORTED

assumptions verifiedADEQUATE

mathematical plausibilityPASS

Per reviewer (3) — the votes behind the verdict

FAILReviewer 1· 90% conf

Statistical methods are appropriate and well-named, assumptions checked, exact p-values and CIs reported, but statistical software is not identified and a clear numerical inconsistency (1,802 vs 1,602 for overall survival denominator) constitutes a demonstrable error, triggering a fail.

Evidence

absence[Methods, Statistical Analysis]

Statistical software not identified.

direct quote[Results, Efficacy Analyses]

“A total of 94 patients died of 1,802 evaluated for the overall survival endpoint”

direct quote[Results, Efficacy Analyses]

“hazard ratio, 0.88; 95% confidence interval, 0.60 to 1.28; P=0.51”

PASSReviewer 2· 85% conf

Statistical methods are well-described, including tests, assumptions, exact p-values, and effect sizes with confidence intervals. However, the statistical software used is not identified. Data presentation is appropriate for a clinical trial.

Evidence

direct quote[Methods, Statistical Analysis]

“Differences between treatment arms were assessed by stratified log rank test... Assumption of proportionality of hazards between treatment groups was tested for all time-to-event endpoints.”

direct quote[Results, Efficacy Analyses]

“Regional nodal irradiation did not significantly improve the interval until invasive breast cancer recurrence or death from breast cancer (hazard ratio 0.88; 95% confidence interval [CI], 0.60 to 1.28; P = 0.51).”

absence[Methods, Statistical Analysis]

Statistical software is not identified.

PASSReviewer 3· 85% conf

Statistical methods are adequately described with named tests, effect sizes and CIs reported, and proportional hazards assumption verified, but exact p-values for secondary endpoints are missing and statistical software is not identified.

Evidence

direct quote[Methods, Statistical Analysis]

“Differences between treatment arms were assessed by stratified log rank test...Assumption of proportionality of hazards between treatment groups was tested for all time-to-event endpoints.”

direct quote[Results, Efficacy Analyses]

absence[Methods, Statistical Analysis]

Statistical software not identified.

The paper does not contain a data availability statement (e.g., where data can be accessed). Only the ClinicalTrials.gov registration number is provided. For a clinical trial, a data availability statement is required. Repository deposit and code sharing are not applicable (patient-level data not publicly deposited, no custom code described). Thus the single applicable criterion is not met.

Sub-criteria

code sharingNOT REPORTED

accession numbersN/A

repository depositNOT REPORTED

data availability statementNOT REPORTED

Per reviewer (3) — the votes behind the verdict

FAILReviewer 1· 95% conf

No data availability statement is present in the paper, no repository deposit, and custom code is not shared; the only applicable criterion (data_availability_statement) is not reported, leading to fail.

Evidence

absence[Entire paper]

No data availability statement.

direct quote[Abstract and end of article]

“ClinicalTrials.gov number, NCT01872975”

FAILReviewer 2· 90% conf

The paper lacks a data availability statement. Clinical trial data are typically controlled-access, but the paper does not describe any mechanism for data access. No code or data repositories are mentioned.

Evidence

absence[Entire manuscript]

No data availability statement is present in the manuscript.

direct quote[Abstract and Methods]

“ClinicalTrials.gov number, NCT01872975 (https://clinicaltrials.gov/ct2/show/NCT01872975).”

FAILReviewer 3· 95% conf

No data availability statement is provided, which is required for a clinical trial; no data or code repositories are mentioned.

Evidence

absence[Entire paper]

No data availability statement is present.

Methods are detailed enough for replication. Trial registration is provided (NCT01872975). Primary and secondary endpoints are fully reported, including negative results. Limitations (low event rate, no N0i+ data, subgroup cautions) are discussed. Conclusions are proportional to the neutral result. Funding (NIH grants) and COI statements are present. Reporting guideline not mentioned, but this alone does not warrant a warn given all other criteria are adequate.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineNOT REPORTED

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

Methods are complete, trial registered, all outcomes reported, limitations discussed, conclusions proportional, and funding/COI statements provided. The only missing element is an explicit reporting guideline (CONSORT).

Evidence

direct quote[Abstract and end of article]

“ClinicalTrials.gov number, NCT01872975”

direct quote[Discussion]

“Our trial has some limitations. The observed rate of the primary end point (8.2%) was around one third lower than the rate projected ...”

direct quote[Acknowledgments and Footnotes]

“Supported by grants from the National Institutes of Health, U10CA180868, U10CA180822, UG1CA189867, and U24CA196067 ... Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.”

PASSReviewer 2· 85% conf

The manuscript reports methods in sufficient detail, includes trial registration, discusses limitations, and has proportional conclusions. However, it does not reference a specific reporting guideline (e.g., CONSORT).

Evidence

direct quote[Abstract and Methods]

“ClinicalTrials.gov number, NCT01872975.”

absence[Methods]

No reference to a reporting guideline (e.g., CONSORT) is found.

direct quote[Discussion]

“Our trial has some limitations. The observed rate of the primary end point (8.2%) was around one third lower than the rate projected...”

PASSReviewer 3· 90% conf

The paper is well-reported with trial registration, detailed methods, all outcomes reported, limitations discussed, and proportional conclusions, but adherence to a reporting guideline (e.g., CONSORT) is not explicitly stated.

Evidence

direct quote[Abstract, Methods, and Footnotes]

“ClinicalTrials.gov number, NCT01872975 (https://clinicaltrials.gov/ct2/show/NCT01872975).”

direct quote[Discussion, paragraph 4]

“Our trial has some limitations. The observed rate of the primary end point (8.2%) was around one third lower than the rate projected on the basis of the combined analysis of the NSABP B-18 and B-27 trials...”

absence[Methods]

Reporting guideline adherence is not mentioned.

9 copyedit issues flagged (1 major): mostly consistency, clarity, grammar.

Checked 29 references: 29 verified.

Reproducibility

1 data/code link checked; 1 live.

Registered (1 ID: ClinicalTrials.gov). No reporting guideline cited.

Adcurare Rigor Action ItemsFinal pass before journal submission

In this post-publication audit, the paper has a core numerical inconsistency (1,802 vs. 1,602) that an informed reader should weigh as a potential data-entry error, and lacks a data availability statement and participant sex reporting. These issues warrant an erratum or correction; independent re-analysis would also be prudent to confirm that the inconsistency does not propagate to other results.

1.
HIGHstatistics
Correct the numerical inconsistency in Results, Efficacy Analyses: change '1,802' to '1,602' to match the total patients with follow-up data.
This demonstrable error (confirmed by copyedit and integrity checks) undermines reader trust in the reported analyses and must be addressed in a correction.
2.
HIGHdata code
Add a data availability statement specifying how de-identified individual patient data can be accessed (e.g., via the NCTN/NCORP Data Archive or YODA project), with conditions and a DOI if applicable.
Current manuscript lacks any data access information, which is expected for clinical trials and is a common journal requirement.
3.
HIGHreporting
Report the sex of participants explicitly in Table 1 (e.g., 'All patients were female' or include a sex row).
Sex is a critical biological variable in breast cancer; its absence is a notable gap that limits generalizability assessment.
4.
HIGHreporting
Add a statement of compliance with the Declaration of Helsinki or ICH-GCP in the Methods section.
Regulatory compliance is a standard expectation for human-subject research; its absence is a minor but fixable gap.
5.
HIGHrigor
Identify the manufacturer and model of the radiation therapy equipment (linear accelerator) and treatment planning software (name and version) in the Radiation Therapy Regimens section.
Replication of the intervention requires specifying equipment; this is an investigational resource in a device/radiotherapy trial.
6.
HIGHstatistics
Specify the statistical software (e.g., SAS version 9.4, R version 4.x) used for all analyses in the Statistical Analysis section.
Software identification is needed for reproducibility and is a standard reporting expectation.
7.
MEDIUMreporting
Describe the randomization method (e.g., centralized permuted-block randomization) and allocation concealment in the Methods.
CONSORT requires explicit randomization method description; current text only says 'randomly assigned.'
8.
MEDIUMreporting
Acknowledge the open-label design and provide a brief rationale (e.g., 'Sham radiation was not feasible or ethical').
Even when blinding is impossible, stating its absence and rationale is expected for trial transparency.
9.
MEDIUMreporting
Report weight and health status (e.g., ECOG performance status) of participants in baseline characteristics.
These factors affect treatment tolerance and outcome generalizability; age alone is insufficient.
10.
MEDIUMreporting
Mention adherence to CONSORT 2010 reporting guidelines in the Methods and confirm a flow diagram was included.
Many journals require explicit reporting guideline adherence for clinical trials.
11.
MEDIUMstatistics
Provide exact p-values for all secondary endpoints (locoregional recurrence-free interval, distant recurrence-free interval, disease-free survival, overall survival) in the results text or tables.
Only the primary endpoint's exact p-value is given; secondary endpoints should be fully transparent.
12.
LOWcopyedit
Fix the incomplete placeholder '( in the )' in Methods, Trial Design and Eligibility — replace with a proper reference to the Supplementary Appendix figure.
This is a broken cross-reference that would confuse readers.
13.
LOWcopyedit
Remove the redundant conjunction in 'they vouch' — rephrase to 'the authors had full access to the data, analyzed them, and vouch for the accuracy...' in Methods.
Improves readability and removes a grammatical inconsistency.
14.
LOWrigor
Either provide supporting data from this trial for the claim that results are 'equally applicable to moderately hypofractionated radiation therapy' (Discussion) or remove the claim.
The claim_audit flagged this as unsupported; the trial used conventional fractionation and only cites an external reference.

Full text (43,920 chars)Analyzed: Jul 16, 2026

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Omitting Regional Nodal Irradiation after Response to Neoadjuvant Chemotherapy

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DOI

10.1056/nejmoa2414859

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