Locoregional PMRT is recommended for women with 4 or more positive axillary lymph nodes .
The role of PMRT in women with 1 to 3 positive axillary lymph nodes is unclear .
Locoregional PMRT is generally not recommended for women who have tumours that are less than 5 cm in diameter and who have negative axillary nodes .
OBJECTIVE To provide information and recommendations to assist women with breast cancer and their physicians in making decisions regarding the use of locoregional post-mastectomy radiotherapy ( PMRT ) .
OUTCOMES Locoregional control , disease-free survival , overall survival and treatment-related toxicities .
To reduce the risk of lymphedema , radiation of the entire axilla should not be used routinely after complete axillary dissection of level I and II lymph nodes .
The use of modern techniques in radiotherapy planning is recommended to minimize excessive normal tissue exposure , particularly to the cardiac and pulmonary structures .
Common short-term side effects of PMRT , including fatigue and skin erythema , are generally tolerable and not dose-limiting .
Severe long-term side effects , including lymphedema , cardiac and pulmonary toxicities , brachial plexopathy , rib fractures and secondary neoplasms , are relatively rare .
Adjuvant treatment of postmenopausal patients with high risk primary breast cancer. Results from the Danish adjuvant trials DBCG 77 C and DBCG 82 C.
The efficacy of adjuvant treatment with tamoxifen was evaluated in protocol DBCG 77 C. Postmenopausal high risk patients ( tumor greater than 5 cm , positive axillary nodes , or invasion to skin/fascia ) were r and omized after total mastectomy and axillary sampling to postoperative radiotherapy ( control ) or to radiotherapy plus treatment with tamoxifen ( TAM ) , 30 mg daily for 1 year . A total of 1,716 patients entered the study . At 8 years of follow-up , ( 7 years median time of observation ) , we observed a significant increase of recurrence-free survival for the TAM treated group and a reduction in mortality , which is significant for patients less than 70 years of age . Retrospectively , an increased recurrence-free survival in TAM treated patients was significant in the following subgroups : tumor less than 5 cm , positive lymph nodes , anaplasia grade II and estrogen receptor level greater than 100 fmol/mg cytosol protein . In the subsequent trial ( DBCG 82 C ) , 1,347 postmenopausal patients less than 70 years were r and omized to one of the following 3 regimens : radiotherapy + tamoxifen , 30 mg daily for 1 year ( TAM ) , TAM alone , or TAM + CMF ( CMF i.v . day 1 every 4 weeks x 9 ) . The survival is similar in the 3 groups at 4 years ( 2 years median time of observation )
Locoregional PMRT is recommended for women with 4 or more positive axillary lymph nodes .
The role of PMRT in women with 1 to 3 positive axillary lymph nodes is unclear .
Locoregional PMRT is generally not recommended for women who have tumours that are less than 5 cm in diameter and who have negative axillary nodes .
OBJECTIVE To provide information and recommendations to assist women with breast cancer and their physicians in making decisions regarding the use of locoregional post-mastectomy radiotherapy ( PMRT ) .
OUTCOMES Locoregional control , disease-free survival , overall survival and treatment-related toxicities .
To reduce the risk of lymphedema , radiation of the entire axilla should not be used routinely after complete axillary dissection of level I and II lymph nodes .
The use of modern techniques in radiotherapy planning is recommended to minimize excessive normal tissue exposure , particularly to the cardiac and pulmonary structures .
Common short-term side effects of PMRT , including fatigue and skin erythema , are generally tolerable and not dose-limiting .
Severe long-term side effects , including lymphedema , cardiac and pulmonary toxicities , brachial plexopathy , rib fractures and secondary neoplasms , are relatively rare .