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 .
Long-term cardiac sequelae in operable breast cancer patients given adjuvant chemotherapy with or without doxorubicin and breast irradiation.
PURPOSE To investigate long-term cardiac sequelae associated with anthracycline use in adjuvant chemotherapy of patients with early breast cancer . PATIENTS AND METHODS All 1,000 patients from three prospect i ve trials of adjuvant chemotherapy containing doxorubicin ( n = 637 , median total dose of 294 mg/m(2 ) ) or not containing the anthracycline ( cyclophosphamide , methotrexate , and fluorouracil [ CMF ] regimen alone , n = 363 ) were analyzed for the relative incidence of congestive heart failure ( CHF ) and myocardial infa rct ion ( MI ) during 14 years of follow-up . The 462 women continuously free of disease as of February 1996 were recalled , and 355 consented to undergo evaluation including 12-lead ECG  and cardiac ultrasound with determination of left ventricular ejection fraction ( LVEF ) to assess the relative incidence of abnormalities in long-term survivors . RESULTS Among the 1,000 patients , there were six cases of CHF and three cases of MI . Cumulative cardiac mortality accounted for 0.4 % ( doxorubicin-treated = 0.6 % ; CMF-treated = 0 ) . Eighteen ( 5 % ) of the 355 patients undergoing cardiac evaluation after median 11 years of follow-up presented systolic dysfunction as defined by pathologic ( < 50 % , n = 8) or borderline ( 50 % to 55 % , n = 10 ) LVEF . Systolic dysfunction was higher in doxorubicin-treated ( 15 of 192 ; 8 % ) than in CMF-treated patients ( three of 150 ; 2 % ) . Breast irradiation had a significant impact on the occurrence of early CHF ( four of 116 ; 3 % ) , but not on systolic dysfunctions . CONCLUSION At longer than 10 years of follow-up , the use of doxorubicin at a total dose commonly applied in regimens of adjuvant chemotherapy does not lead to cardiac clinical sequelae that counter-balance the benefit of treatment in patients with operable breast cancer who may be cured of their disease
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 .