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 .
Risk factors for locoregional recurrence among breast cancer patients: results from International Breast Cancer Study Group Trials I through VII.
PURPOSE To explore prognostic factors for locoregional failures ( LRF ) among women treated for invasive breast cancer within clinical trials of adjuvant therapies . PATIENTS AND METHODS The study population consisted of 5,352 women who were treated with a modified radical mastectomy and enrolled in one of seven International Breast Cancer Study Group r and omized trials . A total of 1,275 women with node-negative disease received either no adjuvant therapy or a single cycle of perioperative chemotherapy , and 4,077 women with node-positive disease received adjuvant chemotherapy of at least 3 months ' duration and /or tamoxifen . Median follow-up is 12 to 15.5 years . RESULTS In women with node-negative disease , factors associated with increased risk of LRF were vascular invasion ( VI ) and tumor size greater than 2 cm for premenopausal and VI for postmenopausal patients . Of the 1,275 patients , 345 ( 27 % ) met criteria for the highest risk groups , and the 10-year cumulative incidences of LRF with or without distant metastases were 16 % for premenopausal and 19 % for postmenopausal women . For the node-positive cohort , number of nodes and tumor grade were factors for both menopausal groups , with additional prediction provided by VI for premenopausal and tumor size for postmenopausal patients . Of the 4,077 patients , 815 ( 20 % ) met criteria for the highest risk groups , and 10-year cumulative incidences were 35 % for premenopausal and 34 % for postmenopausal women . CONCLUSION LRFs are a significant problem after mastectomy alone even for some patients with node-negative breast cancer , as well as after mastectomy and adjuvant treatment for some subgroups of patients with node-positive disease . In addition to number of positive lymph nodes , predictors of LRF include tumor-related factors , such as vascular invasion , higher grade , and larger size
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 .