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 .
Adjuvant postoperative radiotherapy, chemotherapy, and immunotherapy in stage III breast cancer
One hundred twenty pathologically confirmed operable Stage III ( T3N0–2 ) breast cancer patients were r and omized to receive either postoperative radiotherapy or chemotherapy , or a combination of these , with or without levamisole immunotherapy . Radiotherapy was given to regional lymph node areas and chest wall . Chemotherapy consisted of 6 cycles of Adriamycin ( doxorubicin ) ( 45 mg/m2 ) , vincristine ( 1.2 mg/m2 ) intravenously , and cyclophosphamide ( 200 mg/m2 for 5 days ) perorally every 4 weeks . Peroral levamisole , 150 mg a day , 2 days weekly , was given as an immunotherapy . The 3‐year results are described in this article . The effect of levamisole on the prognosis can not be evaluated yet because of the short follow‐up period . The disease‐free survival was almost equal in each patient group , however , some benefit was achieved by levamisole ( a shift of disease‐free survival from 12 to 18 months ) . The patients receiving radiotherapy alone had the poorest prognosis : 68 % had a recurrent tumor , and 57 % were alive . In the chemotherapy group , the figures were 53 % and 72 % , respectively . Patients who received a combined treatment had the best prognosis : 13 % had a recurrent tumor , and 90 % survived 3 years . There was a statistically significant difference in the recurrence rate between any single therapy and the combined treatment ( radiotherapy to combined treatment , P < 0.001 , chemotherapy to combined treatment , P ± 0.01 chi‐square test ) . In overall survival , a statistically significant difference was reached between radiotherapy and combination treatment groups ( P < 0.01 , chi‐square test ) . Radiotherapy gave a good local control of the tumor , and chemotherapy  decreased the number of metastases . The nonmetastatic axillary lymph node status and secondary amenorrhea or severe menstrual disturbances were of positive prognostic value . The side effects due to radiotherapy and chemotherapy were moderate and tolerable . The dose of Adriamycin had to be reduced only in four patients . All of the patients receiving chemotherapy had a transient total alopecia . Three of them had nonlethal arrhythmias , and one had skin rash .  Levamisole was found very toxic with 9 cases of transient agranulocytosis , leading to the discontinuation of immunotherapy in 22 of 59 patients . Our results show that radiotherapy controls the tumor only locally and chemotherapy systematic ally , but the best patient‐saving results are achieved with a combination of radiotherapy and chemotherapy . The disease‐free and overall survival are statistically significant , and favor the combined therapy
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 .