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 .
Effects of tamoxifen on pulmonary fibrosis after cobalt-60 radiotherapy in breast cancer patients.
BACKGROUND AND PURPOSE This study was performed to investigate whether the tamoxifen ( TAM ) induced the development of pulmonary fibrosis after post-mastectomy cobalt-60 ( Co-60 ) irradiation of chest wall and regional lymphatics in patients with breast cancer along with patient age , menopausal status , body weight , observation time and adjuvant chemotherapy regimens . MATERIAL S AND METHODS In this prospect i ve study , 74 patients treated with post-mastectomy adjuvant radiotherapy ( RT ) and TAM and 37 patients treated with RT were evaluated by axial computerized tomography ( CT ) . CT was first performed before initiation of radiotherapy and TAM treatment . A total of 824 thorax CT sections were evaluated by a radiologist blindly . Comparison of pre-treatment and post-treatment CT sections was used to monitor the development of pulmonary fibrosis . RESULTS Pulmonary fibrosis developed in 26 of 74 patients who were treated with RT and TAM combination . It was found in five of 37 women treated only with RT . The difference was statistically significant ( P<0.01 ) . The median time for the development of pulmonary fibrosis was 8 months in TAM-treated patients whereas it was 10 months in non-TAM-treated patients . Among 111 patients who participated in that study , 65 were in the post-menopausal state and 46 in pre-menopausal state . In the multivariate analysis , the independent prognostic factors were age ( P=0.010 ) and menopausal status ( P=0.019 ) . Advanced age and post-menopausal status predisposed to pulmonary fibrosis . The time interval in the development of lung fibrosis and body weight did not significantly influence the results . The time interval which is one independent prognostic factor was found to be associated with lung fibrosis under only-RT group in multivariate analysis ( P<0.01 ) . CONCLUSION TAM treatment during post-mastectomy RT in breast cancer patients significantly increases the risk of the development of lung fibrosis along with the patient age and menopausal status
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 .