Treatment with post-mastectomy radiotherapy (PMRT) reduces the risk for locoregional failure (LRF) recurrence and mortality among patients with T1-2 breast cancer and 1 to 3 positive axillary nodes, according to a guideline update published in the Journal of Clinical Oncology. 1

A joint panel consisting of members from the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology, and the Society of Surgical Oncology evaluated a systematic literature review conducted by Cancer Care Ontario to develop an update on the ASCO guideline regarding PMRT.

While the panel was in “unanimous” agreement that PMRT reduces LRF, recurrence, and mortality upon reviewing the available evidence, they also stated that some subsets of patients are at such low risk for LRF that any benefit of the treatment modality is outweighed by potential toxicities. They agreed that clinicians who make recommendations for PMRT should consider factors that reduce the risk for LRF and increase the risk for complications.

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Upon positive sentinel node biopsy, if clinicians and patients decide to omit axillary dissection, the panel recommends that these patients receive PMRT only when there is sufficient information to justify its use without needing to know if additional axillary nodes are involved.

Treatment with PMRT is recommended to be administered to internal mammary nodes and supraclavicular-axillary apical nodes, as well as the chest wall or reconstructed breast.


  1. Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. J Clin Oncol. 2016 Sep 19. doi: 10.1200/JCO.2016.69.1188 [Epub ahead of print.]