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 .
Postoperative radiotherapy following mastectomy for high-risk breast cancer. A randomised trial.
Grade III , node-positive breast cancer carries a high risk of loco-regional relapse after simple mastectomy . A r and omised trial was conducted to assess whether this would be significantly reduced by postoperative radiotherapy .  Between 1985 and 1991 , 76 patients who had undergone a simple mastectomy and axillary sampling , and whose tumours had been found to be grade III and node-positive , were r and omised to receive postoperative radiotherapy to the chest wall and axilla or no further loco-regional treatment . Radiotherapy was delivered with 8 MV X-rays to the axilla and supraclavicular fossa and with 8 MeV electrons to the chest wall , to a dose of 45 Gy in 15 fractions over 3 weeks . All patients have been followed-up until death , or for a minimum of 10 years . All loco-regional recurrences occurred within the first 4 years after mastectomy . There were 26 such events in the 40 patients r and omised to the ' watch ' policy ( 65 % ) , as opposed to 9 out of 36 ( 25 % ) who received radiotherapy ( P<0.01 ) . Ten-year survival was 39 % in the radiotherapy arm as opposed to 25 % in the no radiotherapy arm . Recruitment to the trial was closed in 1991 , when a preliminary safety analysis revealed the size of the effect of radiotherapy , and from then on all node-positive patients with grade III tumours have routinely been given this treatment . Further follow-up has confirmed this finding , as borne out by these 10-year results , which shows that radiotherapy has a significant impact on reducing loco-regional recurrence in patients at high risk after mastectomy . There is an apparent survival benefit although , because of the small numbers in this trial , this has not reached statistical significance
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 .