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 .
Cardiac effects of adjuvant doxorubicin and radiation therapy in breast cancer patients.
PURPOSE To assess the cardiac effects of two different cumulative doses of adjuvant doxorubicin and radiation therapy ( RT ) in breast cancer patients . PATIENTS AND METHODS Two hundred ninety-nine breast cancer patients were prospect ively r and omized to receive either five cycles ( CA5 ) or 10 cycles ( CA10 ) of adjuvant treatment with cyclophosphamide ( 500 mg/ m2 ) and doxorubicin ( 45 mg/m2 ) administered by intravenous bolus every 21 days . One hundred twenty-two of these patients also received RT . Estimates of the cardiac RT dose-volume were retrospectively categorized as low , moderate , or high . The risk of major cardiac events ( congestive heart failure , acute myocardial infa rct ion ) was assessable in 276 patients ( 92 % ) , with a median follow-up time of 6.0 years ( range , 0.5 to 19.4 ) . RESULTS The estimated risk ( 95 % confidence interval ) of cardiac events per 100 patient-years was significantly higher for CA10 than for CA5 [ 1.7 ( 1.0 to 2.8 ) v 0.5 ( 0.1 to 1.2 ) ; P=.02 ] . The risk of cardiac events in CA5 patients , irrespective of the cardiac RT dose-volume , did not differ significantly from rates of cardiac events predicted for the general female population by the Framingham Heart Study . In CA10 patients , the incidence of cardiac events was significantly increased ( relative risk ratio , 3.6 ; P < .00003 ) compared with the Framingham population , particularly in groups that also received moderate and high dose-volume cardiac RT . CONCLUSION Conventional-dose adjuvant doxorubicin as delivered in the CA5 regimen by itself , or in combination with locoregional RT , was not associated with a significant increase in the risk of cardiac events . Higher doses of adjuvant doxorubicin ( CA10 ) were associated with a threefold to fourfold increased risk of cardiac events . This appears to be especially true in patients treated with higher dose-volumes of cardiac RT . Larger studies with longer follow-up periods are needed to confirm these results
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 .