Procedure: Tailored axillary surgery;Radiation: Radiotherapy - Arm A;Radiation: Radiotherapy - Arm B

Inclusion Criteria:

Inclusion criteria at pre-registration:

- Written informed consent according to ICH/GCP regulations prior to any trial specific
procedures.

- Breast cancer, node positive detected by palpation or imaging

- Planned neoadjuvant treatment (e.g. chemotherapy or endocrine therapy) allowed

- Female or male aged = 18 years

- Ability to complete the Quality of Life questionnaires

Inclusion criteria at registration:

- Node-positive breast cancer (histologically or cytologically proven both in primary
tumor and in lymph node) AJCC/UICC [42] stage II-III (all molecular subtypes allowed):

- Node-positivity detected by imaging (iN+) and confirmed by pathology without
neoadjuvant treatment

- Node-positivity detected by palpation (cN1-2) and confirmed by pathology without
neoadjuvant treatment

- Eligible for primary ALND or sentinel lymph node procedure with frozen section and
either:

- Newly diagnosed

- Isolated in-breast recurrence or second ipsilateral breast cancer (at least 5
years disease free and no prior axillary surgery or loco regional RT)

- Baseline Quality of Life questionnaire has been completed

- WHO performance status 0-2

- Adequate condition for general anesthesia and breast cancer surgery

- Women with child-bearing potential are using effective contraception, are not pregnant
or lactating and agree not to become pregnant during trial treatment and thereafter
during the time recommended by the guidelines for adjuvant systemic therapies. A
negative pregnancy test before inclusion into the trial is required for all women with
child-bearing potential.

- Men agree not to father a child during trial treatment and thereafter during 6 months.

Inclusion criteria at randomization (intraoperatively)

- Node-positive breast cancer (histologically or cytologically proven both in primary
tumor and in lymph node) AJCC/UICC [42] stage II-III (all molecular subtypes allowed):

- Node-positivity initially detected by imaging (negative on palpation) and
reconfirmed by pathology (residual disease) (in SLN or non SLN during surgery)
after neoadjuvant treatment

- Node-positivity initially detected by palpation and reconfirmed by pathology
(residual disease) after neoadjuvant treatment

Exclusion Criteria:

Exclusion criteria at pre-registration:

Any potential patient who meets any of the following criteria has to be excluded from
entering the trial.

- Clinical N3 breast cancer

- Clinical N2 breast cancer, if limited to the internal mammary nodes only

- Contralateral breast cancer

- Prior axillary surgery (except prior sentinel node procedure in breast recurrence)

- Prior regional radiotherapy

- History of hematologic or primary solid tumor malignancy, unless in remission for at
least 5 years from pre-registration with the exception of adequately treated cervical
carcinoma in situ or localized non-melanoma skin cancer.

- Concurrent treatment with any other experimental drug within 30 days of
pre-registration

- Concomitant use of other anti-cancer drugs or radiotherapy

- Any other serious underlying medical, psychiatric, psychological, familial or
geographical condition, which in the judgment of the investigator may interfere with
the planned staging, treatment and follow-up, affect patient compliance or place the
patient at high risk from treatment-related complications.

Exclusion criteria at randomization (intraoperatively):

Any potential patient who meets any of the following criteria has to be excluded from the
trial.

- Absence of clip in the specimen radiography

- No palpable disease left behind in the axilla during Tailored Axillary Surgery

- Sentinel lymph node outside the axilla