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 .
The combination of radiotherapy, adjuvant chemotherapy (cyclophosphamide-doxorubicin-ftorafur) and tamoxifen in stage II breast cancer. Long-term follow-up results of a randomised trial.
Two hundred patients with node positive stage II breast cancer were r and omised to four groups after radical mastectomy and axillary evacuation : ( 1 ) Postoperative radiotherapy , ( 2 ) Adjuvant chemotherapy with eight courses of CAFt ( cyclophosphamide 500 mg m-2 + doxorubicin 40 mg/m-2 + ftorafur 20 mg kg-1 orally day 1 - 14 ) every fourth week , ( 3 ) Postoperative radiotherapy and adjuvant chemotherapy and ( 4 ) postoperative radiation , adjuvant chemotherapy and tamoxifen 40 mg daily for 2 years . Thirty-two per cent of the patients discontinued treatment due to GI-toxicity , while 26 % required dose reductions due to leukopenia . Radiation pneumonitis was more frequent after the combination of postoperative radiotherapy with chemotherapy . There was a better relapse-free survival in the groups receiving chemotherapy compared to radiotherapy alone ( P = 0.05 ) , which was highly significant in a multivariate Cox analysis ( P = 0.004 ) . No significant survival differences were seen . Tamoxifen had no clear overall effect but there were better relapse-free ( P = 0.04 ) and overall ( P = 0.004 ) survival with tamoxifen in estrogen receptor positive patients , while estrogen receptor negative patients had a somewhat poorer survival ( P = 0.07 ) after tamoxifen .  Local control was better ( NS ) after the combination ( 93 % ) radiotherapy and chemotherapy compared to either treatment alone ( 76 % with radiotherapy and 74 % with chemotherapy at 5 years )
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 .