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 .
Radiation-induced brachial plexopathy: neurological follow-up in 161 recurrence-free breast cancer patients.
PURPOSE The purpose was to assess the incidence and clinical manifestations of radiation-induced brachial plexopathy in breast cancer patients , treated according to the Danish Breast Cancer Cooperative Group protocol s. METHODS AND MATERIAL S One hundred and sixty-one recurrence-free breast cancer patients were examined for radiation-induced brachial plexopathy after a median follow-up period of 50 months ( 13 - 99 months ) . After total mastectomy and axillary node sampling , high-risk patients were r and omized to adjuvant therapy .  One hundred twenty-eight patients were treated with postoperative radiotherapy with 50 Gy in 25 daily fractions over 5 weeks . In addition , 82 of these patients received cytotoxic therapy ( cyclophosphamide , methotrexate , and 5-fluorouracil ) and 46 received tamoxifen . RESULTS Five percent and 9 % of the patients receiving radiotherapy had disabling and mild radiation-induced brachial plexopathy , respectively . Radiation-induced brachial plexopathy was more frequent in patients receiving cytotoxic therapy ( p = 0.04 ) and in younger patients ( p = 0.04 ) . The clinical manifestations were paraesthesia ( 100 % ) , hypaesthesia ( 74 % ) , weakness ( 58 % ) , decreased muscle stretch reflexes ( 47 % ) , and pain ( 47 % ) . CONCLUSION The brachial plexus is more vulnerable to large fraction size . Fractions of 2 Gy or less are advisable . Cytotoxic therapy adds to the damaging effect of radiotherapy . Peripheral nerves in younger patients seems more vulnerable . Radiation-induced brachial plexopathy occurs mainly as diffuse damage to the brachial plexus
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 .