title: DEGRO practical guidelines for radiotherapy of breast cancer IV: radiotherapy following mastectomy for invasive breast cancer.
abstract: OBJECTIVE
  Since the last recommendations from the Breast Cancer Expert Panel of the German Society for Radiation Oncology (DEGRO) in 2008, evidence for the effectiveness of postmastectomy radiotherapy (PMRT) has grown. This growth is based on updates of the national S3 and international guidelines, as well as on new data and meta-analyses. New aspects were considered when updating the DEGRO recommendations.
  
  
  METHODS
  The authors performed a comprehensive survey of the literature. Data from recently published (meta-)analyses, randomized clinical trials and international cancer societies' guidelines yielding new aspects compared to 2008 were reviewed and discussed. New aspects were included in the current guidelines. Specific issues relating to particular PMRT constellations, such as the presence of risk factors (lymphovascular invasion, blood vessel invasion, positive lymph node ratio >20 %, resection margins <3 mm, G3 grading, young age/premenopausal status, extracapsular invasion, negative hormone receptor status, invasive lobular cancer, size >2 cm or a combination of ≥ 2 risk factors) and 1-3 positive lymph nodes are emphasized.
  
  
  RESULTS
  The evidence for improved overall survival and local control following PMRT for T4 tumors, positive resection margins, >3 positive lymph nodes and in T3 N0 patients with risk factors such as lymphovascular invasion, G3 grading, close margins, and young age has increased. Recently identified risk factors such as invasive lobular subtype and negative hormone receptor status were included. For patients with 1-3 positive lymph nodes, the recommendation for PMRT has reached the 1a level of evidence.
  
  
  CONCLUSIONS
  PMRT is mandatory in patients with T4 tumors and/or positive lymph nodes and/or positive resection margins. PMRT should be strongly considered in patients with T3 N0 tumors and risk factors, particularly when two or more risk factors are present.
authors.affiliation: Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany, Frederik.Wenz@medma.uni-heidelberg.de.
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
authors.forename: Elena
authors.initials: E
authors.lastname: Sperk
authors.forename: Wilfried
authors.initials: W
authors.lastname: Budach
authors.forename: Jürgen
authors.initials: J
authors.lastname: Dunst
authors.forename: Petra
authors.initials: P
authors.lastname: Feyer
authors.forename: Rainer
authors.initials: R
authors.lastname: Fietkau
authors.forename: Wulf
authors.initials: W
authors.lastname: Haase
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Harms
authors.forename: Marc D
authors.initials: MD
authors.lastname: Piroth
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Sautter-Bihl
authors.forename: Felix
authors.initials: F
authors.lastname: Sedlmayer
authors.forename: Rainer
authors.initials: R
authors.lastname: Souchon
authors.forename: Christoph
authors.initials: C
authors.lastname: Fussl
authors.forename: Rolf
authors.initials: R
authors.lastname: Sauer
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008408:Mastectomy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000401:mortality / Q000473:pathology / Q000628:therapy; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015996:Survival Rate