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 .
Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation.
In 1971 we began a r and omized trial to compare alternative local and regional treatments of breast cancer , all of which employ breast removal . Life-table estimates were obtained for 1665 women enrolled in the study for a mean of 126 months . There were no significant differences among three groups of patients with clinical ly negative axillary nodes , with respect to disease-free survival , distant-disease -- free survival , or overall survival ( about 57 per cent ) at 10 years . The patients were treated by radical mastectomy , total ( " simple " ) mastectomy without axillary dissection but with regional irradiation , or total mastectomy without irradiation plus axillary dissection only if nodes were subsequently positive . Similarly , no differences were observed between patients with clinical ly positive nodes treated by radical mastectomy or by total mastectomy without axillary dissection but with regional irradiation .  Survival at 10 years was about 38 per cent in both groups . Our findings indicate that the location of a breast tumor does not influence the prognosis and that irradiation of internal mammary nodes in patients with inner-quadrant lesions does not improve survival . The data also demonstrate that the results obtained at five years accurately predict the outcome at 10 years . We conclude that the variations of local and regional treatment used in this study are not important in determining survival of patients with breast cancer
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 .