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 5-year results of a randomized trial of adjuvant radiation therapy after chemotherapy in breast cancer patients treated with mastectomy.
The use of adjuvant radiation therapy in breast cancer patients treated with mastectomy and adjuvant chemotherapy  has been controversial . In order to assess the necessity and effectiveness of adjuvant radiation therapy in this setting , we review ed the results in 510 patients with T1-T3 tumors and pathologically positive nodes or tumors larger than 5 cm and negative nodes who were treated with adjuvant chemotherapy . Patients with four or more positive nodes or at least one positive apical node were r and omized to receive either five or ten cycles of cyclophosphamide/Adriamycin ( Adria Laboratories , Columbus , OH ) ( CA ) and patients with one to three positive nodes or operable tumors larger than 5 cm and pathologically negative nodes were r and omized to receive eight cycles of either cyclophosphamide , methotrexate , and 5-fluorouracil ( 5-FU ) ( CMF ) or methotrexate and 5-FU ( MF ) chemotherapy .  Two hundred six of these patients were subsequently rer and omized to receive either no further treatment or adjuvant radiotherapy .  Thirty-five patients withdrew after r and omization , including 34 who declined to receive radiotherapy .  Radiation therapy consisted of 4,500 cGy in 5 weeks to the chest wall and appropriate draining lymph nodes . Median follow-up from chemotherapy r and omization is 45 months for patients in the CA arm and 53 months for those in the CMF/MF arm . The crude rate of local failure ( chest wall or draining lymph node areas ) as first site of failure for patients r and omized to receive chemotherapy only was 14 % ; for those r and omized to receive both chemotherapy and radiotherapy it was 5 % ( P = .03 ) . For patients in the CMF/MF arm , the rate of local failure as the first site of failure was nearly the same for patients r and omized to chemotherapy only as for those r and omized to adjuvant radiotherapy as well ( 5 % v 2 % ) . For patients in the CA arm , the crude rate of local failure was 20 % for patients r and omized to receive chemotherapy only , and 6 % for those r and omized to both types of adjuvant treatment ( P = .03 ) . Among the 43 patients treated with CA who actually received radiotherapy , there was only one local failure , compared with 12 local failures among the 59 patients ( 20 % ) who actually did not receive radiotherapy ( P = .007 ) . No significant difference was seen in disease-free survival or overall survival in either the CA or the CMF/MF arm between patients r and omized to receive radiation therapy and those r and omized to no further treatment . ( ABSTRACT TRUNCATED AT 400 WORDS
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 .