Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology.
OBJECTIVE
To determine indications for the use of postmastectomy radiotherapy (PMRT) for patients with invasive breast cancer with involved axillary lymph nodes or locally advanced disease who receive systemic therapy. These guidelines are intended for use in the care of patients outside of clinical trials.


METHODS
The benefits and risks of PMRT in such patients, as well as subgroups of these patients, were considered. The details of the PMRT technique were also evaluated.


RESULTS
The outcomes considered included freedom from local-regional recurrence, survival (disease-free and overall), and long-term toxicity.


METHODS
An expert multidisciplinary panel reviewed pertinent information from the published literature through July 2000; certain investigators were contacted for more recent and, in some cases, unpublished information. A computerized search was performed of MEDLINE data; directed searches based on the bibliographies of primary articles were also performed.


METHODS
Levels of evidence and guideline grades were assigned by the Panel using standard criteria. A "recommendation" was made when level I or II evidence was available and there was consensus as to its meaning. A "suggestion" was made based on level III, IV, or V evidence and there was consensus as to its meaning. Areas of clinical importance were pointed out where guidelines could not be formulated due to insufficient evidence or lack of consensus.


CONCLUSIONS
The recommendations, suggestions, and expert opinions of the Panel are described in this article.


RESULTS
Seven outside reviewers, the American Society of Clinical Oncology (ASCO) Health Services Research Committee members, and the ASCO Board of Directors reviewed this document.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
A
A
Recht
S B
SB
Edge
L J
LJ
Solin
D S
DS
Robinson
A
A
Estabrook
R E
RE
Fine
G F
GF
Fleming
S
S
Formenti
C
C
Hudis
J J
JJ
Kirshner
D A
DA
Krause
R R
RR
Kuske
A S
AS
Langer
G W
GW
Sledge
T J
TJ
Whelan
D G
DG
Pfister
D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008408:Mastectomy; D009361:Neoplasm Invasiveness; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000191:economics; D016019:Survival Analysis