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 .
Randomized trial on the effect of radiotherapy in addition to 6 cycles CMF in node-positive breast-cancer patients. The German Breast-Cancer Study Group.
In 1984 the GBSG started a multicenter r and omized trial to compare the effectiveness of 6 cycles of cyclophosphamide , methotrexate and fluorouracil ( CMF ) with or without radiotherapy ( RT ) as adjuvant treatment in node-positive breast-cancer patients treated by mastectomy .  During 5 years , 199 patients were r and omized . After a median follow-up of about 9 years , the treatment groups 6 x CMF and 6 x CMF + RT were compared regarding time to recurrence and death . As the first event of failure , we observed locoregional recurrence in 22 patients , distant metastases in 66 patients , a secondary malignancy in 9 patients and death without previous event in 5 patients . For event-free survival ( EFS ) , no significant difference was observed [ relative risk ( RR ) 6 x CMF + RT vs. 6 x CMF 0.82 , 95 % confidence interval ( CI ) 0.55 - 1.21 ] . Event-specific analysis showed a significant decreased risk after radiotherapy for locoregional recurrence . The risk for distant metastases was estimated as slightly decreased and the risk for secondary malignancy and for death without previous event was estimated as increased in treatment group 6 x CMF + RT in comparison with treatment group 6 x CMF , but these effects were not significant . For overall survival ( OS ) and breast-cancer-specific survival ( BCS ) , no significant treatment effect could be demonstrated . There is a beneficial effect of radiotherapy on locoregional recurrence . For EFS and BCS , a tendency in favour of radiotherapy is observed , but this is not significant ; for OS , no difference can be demonstrated , but the power of the study is too low to detect small treatment effects
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 .