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 .
A randomized trial of chemotherapy (L-PAM vs CMF) and irradiation for node positive breast cancer
Summary 158 evaluable patients with stage II , lymph node positive , carcinoma of the breast were r and omized to adjuvant therapy with either melphalan ( L-PAM ) or cyclophosphamide , methotrexate , and fluorouracil ( CMF ) after mastectomy . In addition , patients were r and omized to be treated with or without post-operative irradiation therapy ( RT ) in addition to their chemotherapy . At a median follow-up time of 11 years , there is no difference in time to relapse ( P=0.69 ) or survival ( P=0.55 ) among the four treatment groups . Multivariate analysis including treatment arm , age , race , tumor size , histologic type , performance status , time to onset of treatment , menopausal status , and number of positive nodes , revealed that only the number of positive nodes ( < 4 vs ≥ 4 ) was related to disease-free and overall survival . Ten year relapse-free survival for patients with < 4 positive nodes compared to those with ≥4 positive nodes was 63 % versus 30 % , and overall survival 63 % versus 41 % , respectively . Patients who received post-operative radiation therapy had significantly less local recurrence than those treated with chemotherapy alone ( P=0.03 ) but without improvement in relapse-free or overall survival . In this trial , post-operative radiation therapy when added to chemotherapy  decreased the risk of local recurrence without adverse effects on survival . Treatment outcome was not influenced by chemotherapy regimen , but differences may have been obscured by the small sample size
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 .