Consensus Statement on Postmastectomy Radiation Therapy
Reviewers: Li Liu, MD
Source: International Journal of Radiation Oncology, Biology, and Physics, Volume 44, No 5 (July):989-990, 1999
Based on the emerging data from many institutional reports as well as prospective randomized clinical trials, the American Society for Therapeutic Radiology and Oncology (ASTRO) developed a Consensus Summary Statement on postmastectomy radiation therapy (PMRT).
The key elements to this consensus statement are:
- Reduction in the recurrence rate of clinically detectable local-regional disease by PMRT is evident.
- The most recent randomized controlled trials, including two well-designed trials using modern radiation techniques, have shown a moderate and statistically significant improvement in survival.
- Consultation with a radiation oncologist should occur in postmastectomy node-positive patients. Patients with 4 or more positive lymph nodes should receive radiation therapy to improve local control and perhaps survival as well. Greater benefit was seen in patients with 1-3 positive nodes and in patients with smaller tumor burdens.
- In all patients, the chest wall should be treated.
- The treatment of internal mammary nodes remains controversial.
- A supraclavicular field can be used to encompass the axillary apex and supraclavicular area in selected node-positive patients (particularly those with 4 or more positive nodes). A posterior axillary radiation field may be considered in patients with incomplete axillary dissection.
- Effort should be made to minimize the dose to heart and lung.
- The optimal sequencing of chemotherapy and PMRT remains uncertain.