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 sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer.
BACKGROUND Patients with early-stage breast cancer who are at substantial risk for systemic metastases are increasingly treated with breast-conserving therapy and adjuvant chemotherapy . However , the optimal sequencing of chemotherapy and radiation therapy is not clear . METHODS Two hundred forty-four patients with stage I or II breast cancer who were at substantial risk for distant metastases were r and omly assigned to receive a 12-week course of chemotherapy either before or after radiation therapy .  All had had breast-conserving surgery .  The median length of follow-up in surviving patients was 58 months ( range , 10 to 124 ) . RESULTS The five-year actuarial rates of cancer recurrence at any site and of distant metastases in the radiotherapy-first group and the chemotherapy-first group were 38 percent and 31 percent ( P = 0.17 ) and 36 percent and 25 percent ( P = 0.05 ) , respectively . Overall survival was 73 percent and 81 percent ( P = 0.11 ) , respectively . The five-year crude rates of first recurrence according to site in the radiotherapy-first and chemotherapy-first groups , respectively , were 5 percent and 14 percent for local recurrence and 32 percent and 20 percent for distant or regional recurrence or both . This difference in the pattern of recurrence was of borderline statistical significance ( P = 0.07 ) . CONCLUSIONS This study suggests that for patients ar substantial risk for systemic metastases , it is preferable to give a 12-week course of chemotherapy followed by radiation therapy , rather than radiation therapy followed by chemotherapy
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 .