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 .
Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life.
PURPOSE To determine the prevalence of and contributing factors for chronic arm morbidity including lymphedema in breast cancer patients after treatment and to assess the impact of arm morbidity on quality of life ( QOL ) . PATIENTS AND METHODS A four- question screening question naire was developed and mailed to a r and om sample of 744 breast cancer patients treated curatively in two cancer centers from 1993 to 1997 . Patients were without recurrence and at least 2 years from diagnosis . Respondents were classified as with or without arm-related symptoms on the basis of the survey . Stratified r and om sample s from each group were then invited for a detailed assessment of their symptoms and signs , including the presence of lymphedema . Their QOL was assessed by the European Organization for Research and Treatment of Cancer QOL Question naire C-30  and by a detailed arm problem question naire that assessed various aspects of daily arm functioning . RESULTS Approximately half of all screened patients were symptomatic and 12.5 % of all assessed patients had lymphedema . Axillary dissection ( AD ) and axillary radiotherapy ( RT )  after dissection were statistically significantly related to the occurrence of arm symptoms ( odds ratio for AD = 3.3 , P < .001 ; odds ratio for RT = 3.1 , P < .001 ) . Symptomatic patients and patients with lymphedema both had impaired QOL compared with asymptomatic patients . CONCLUSION Treatment for breast cancer is associated with considerable arm morbidity , which has a negative impact on QOL . Arm morbidity should be carefully monitored in future studies involving local treatment modalities for 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 .