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 total incidence of loco-regional recurrence in a randomized trial of breast cancer TNM stage II. The South Sweden Breast Cancer Trial.
We studied loco-regional recurrence during follow-up ( median observation time 8 years ) in 1,153 patients , who underwent modified mastectomy and were r and omly assigned to one of the following postoperative treatments ; Premenopausal patients : radiotherapy , cyclophosphamide , or both ; Post-menopausal patients : radiotherapy , tamoxifen , or both .  Recurrence occurred in a total of 419 patients , 123 of whom had loco-regional recurrence with or without distant metastasis . The loco-regional recurrence rate was 7 % in the irradiated subgroups and 17 % in the non-irradiated subgroups , the corresponding cure rates being 43 % and 58 % . Complete remission of all local recurrence was obtained after the first treatment in 67 % of the cases , and was persistent in 67 % of them ( 44 % overall ) . Complete remission was obtained in all patients with local recurrence who received local treatment only , and was persistent in 65 % . Of local recurrences treated with a combination of surgery , radiotherapy and hormone therapy , complete response was obtained in 94 % of the patients , and was persistent in 94 % of them ( 88 % overall ) . Complete remission of all regional recurrence was obtained after the first treatment in 58 % of the patients and was persistent in 67 % of them ( 39 % overall ) . Postoperative radiotherapy reduced not only the total number of loco-regional recurrences but also the number of uncontrolled loco-regional recurrences . Aggressive local treatment would appear to yield both satisfactory initial control and , when combined with the hormone therapy , a high rate of persistent loco-regional control
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 .