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 .
Treatment-related toxicity from a randomized trial of the sequencing of doxorubicin and radiation therapy in patients treated for early stage breast cancer.
PURPOSE There is concern that breast cancer patients treated with  left-sided radiation therapy ( XRT ) and doxorubicin ( DOX ) may have an increased risk of cardiac toxicity . In addition , the effect of different sequencing of XRT and chemotherapy ( CT ) on the likelihood of cardiotoxicity , as well as cellulitis , arm edema , or brachial plexopathy , is not well understood . We review ed the records of patients treated on a r and omized trial testing the sequencing of CT and XRT  to determine if there was an increase in cardiac events or other complications in patients treated with a total dose of DOX of 180 mg/m2 and XRT , comparing patients with treatment to the left breast and the right breast , and comparing patients treated with initial CT and initial RT . MATERIAL S AND METHODS From June 1984 to December 1992 , 244 patients with clinical stage I or II breast cancer were r and omized following conservative surgery to receive CT ( 4 cycles of CAMFP at 3 week intervals ) either before or after XRT ( 45 Gy to the entire breast , followed by a boost of 16 Gy ; nodal radiation therapy was optional ) . Two hundred thirty-one patients were evaluable for the development of cardiac toxicity . The median age at diagnosis was 45 years ( range , 20 - 68 ) . CT doses were : doxorubicin , 45 mg/m2 IV bolus , d 3 ; methotrexate , 200 mg/m2 IV , d 1 and 15 ; 5-fluorouracil , 500 mg/m2 IV , d 1 ; cyclophosphamide , 500 mg/m2 IV , d 1 ; prednisone 40 mg p.o . , d 1 - 5 . A cardiac event was defined as a myocardial infa rct ion or clinical evidence of congestive heart failure . Median follow-up time was 53 months . RESULTS No cardiac events were observed for patients with either left- or right-sided breast cancer . The sequencing of CT and XRT had no significant effect on the risk of cardiac toxicity , cellulitis , arm edema or brachial plexopathy . CONCLUSIONS We observed no evidence of an increased risk of cardiac toxicity from the addition of left breast tangential irradiation to DOX at a total dose of 180 mg/m2 . Additional follow-up is needed to exclude possible late events . In addition , the sequencing of CT and XRT does not appear to affect the risk of cellulitis , arm edema , or brachial plexopathy
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 .