Updated guidelines for using radiotherapy after breast removal in breast cancer patients

This study reviewed updated guidelines for the use of radiotherapy following mastectomy (surgical removal of the breast) in breast cancer.

Post-mastectomy radiation therapy (PMRT) is widely accepted for patients with four or more involved axillary (underarm) lymph nodes. The axillary lymph nodes are the first nodes breast cancer generally spreads to. PMRT is used to lower the risk of relapse. The use of PMRT in patients with 3 or fewer involved lymph nodes is less clear. The toxic effects of radiotherapy may outweigh the benefit in these patients, as they have a lower rate of cancer recurrence. Radiotherapy can lead to toxicities many years after treatment, including cardiac (heart) disease. The American Society of Clinical Oncology (ASCO) provided guidelines for the use of PMRT written in 2001. They recently met to update these guidelines. 

This study reviewed the updated ASCO guidelines for PMRT.

The group unanimously agreed that PMRT improves the chances of survival in patients with early-stage breast cancer and 1-3 cancerous underarm lymph nodes (which have been removed). However, doctors must consider the individual risk of recurrence and the possibilities of more complications from using PMRT. The patient should be involved in making the decision.

In cases where the underarm lymph nodes are not removed, it is recommended that patients only receive PMRT if it is justified. In patients who have involved lymph nodes following neoadjuvant chemotherapy (chemotherapy delivered before surgery), PMRT is recommended. However, this is based on low-quality evidence.

 The group recommended that PMRT be aimed at the lymph nodes inside the breasts, the lymph nodes near the collarbone/neck, and to the chest wall or reconstructed breast.

This article reviewed the ASCO recommendations for the use of radiotherapy following mastectomy in patients with 3 or fewer involved lymph nodes.