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 .
Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group.
PURPOSE To assess patterns of failure and how selected prognostic and treatment factors affect the risks of locoregional failure ( LRF ) after mastectomy in breast cancer patients with histologically involved axillary nodes treated with chemotherapy with or without tamoxifen without irradiation .  PATIENTS AND METHODS The study population consisted of 2,016 patients entered onto four r and omized trials conducted by the Eastern Cooperative Oncology Group . The median follow-up time for patients without recurrence was 12.1 years ( range , 0.07 to 19.1 years ) . RESULTS A total of 1,099 patients ( 55 % ) experienced disease recurrence . The first sites of failure were as follows : isolated LRF , 254 ( 13 % ) ; LRF with simultaneous distant failure ( DF ) , 166 ( 8 % ) ; and distant only , 679 ( 34 % ) . The risk of LRF with or without simultaneous DF at 10 years was 12.9 % in patients with one to three positive nodes and 28.7 % for patients with four or more positive nodes . Multivariate analysis showed that increasing tumor size , increasing numbers of involved nodes , negative estrogen receptor protein status , and decreasing number of nodes examined were significant for increasing the rate of LRF with or without simultaneous DF . CONCLUSION LRF after mastectomy is a substantial clinical problem , despite the use of chemotherapy with or without tamoxifen . Prospect i ve r and omized trials will be necessary to estimate accurately the potential disease-free and overall survival benefits of postmastectomy radiotherapy for patients in particular prognostic subgroups treated with presently used and future systemic therapy regimens
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 .