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 .
Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation.
PURPOSE The objective of this study was to determine locoregional recurrence ( LRR ) patterns after mastectomy and doxorubicin-based chemotherapy to define subgroups of patients who might benefit from adjuvant irradiation .  PATIENTS AND METHODS A total of 1,031 patients were treated with mastectomy and doxorubicin-based chemotherapy without irradiation on five prospect i ve trials . Median follow-up time was 116 months . Rates of isolated and total LRR ( + /- distant metastasis ) were calculated by Kaplan-Meier analysis . RESULTS The 10-year actuarial rates of isolated LRR were 4 % , 10 % , 21 % , and 22 % for patients with zero , one to three , four to nine , or > /= 10 involved nodes , respectively ( P < .0001 ) . Chest wall ( 68 % ) and supraclavicular nodes ( 41 % ) were the most common sites of LRR . T stage ( P < .001 ) , tumor size ( P < .001 ) , and > /= 2-mm extranodal extension ( P < .001 ) were also predictive of LRR . Separate analysis was performed for patients with T1 or T2 primary disease and one to three involved nodes ( n = 404 ) . Those with fewer than 10 nodes examined were at increased risk of LRR compared with those with > /= 10 nodes examined ( 24 % v 11 % ; P = .02 ) . Patients with tumor size greater than 4.0 cm or extranodal extension > /= 2 mm experienced rates of isolated LRR in excess of 20 % . Each of these factors continued to significantly predict for LRR in multivariate analysis by Cox logistic regression . CONCLUSION Patients with tumors > /= 4 cm or at least four involved nodes experience LRR rates in excess of 20 % and should be offered adjuvant irradiation . Additionally , patients with one to three involved nodes and large tumors , extranodal extension > /= 2 mm , or inadequate axillary dissections experience high rates of LRR and may benefit from postmastectomy irradiation
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 .