The American Society of Clinical Oncology (ASCO) has released an update guideline for the use of postmastectomy radiotherapy (PMRT).
The organization, along with the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO), convened a panel to review current literature regarding the practice. Although PMRT reduces the risks of locoregional failure, recurrence, and breast cancer mortality for patients with T1-2 breast cancer with one to three positive axillary nodes, some subsets of these patients are likely to have such a low risk of locoregional failure that the absolute benefit of the therapy is outweighed by its potential toxicities, the panel concluded.
The new guideline is as follows:
- Clinicians should consider factors that may decrease the risk of locoregional failure, affect the benefit of reduced breast cancer-specific mortality, and/or increase the risk of complications resulting from PMRT.
- When patients elect to omit axillary dissection after a positive sentinel node biopsy, they should receive PMRT only if there is already enough information to justify its use without needing to know if additional axillary nodes are involved.
- Patients with axillary nodal involvement after neoadjuvant systemic therapy should receive PMRT.
- Treatment should be administered to both the internal mammary nodes and the supraclavicular-axillary apical nodes, in addition to the chest wall or reconstructed breast.
