title: Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update.
abstract: A joint American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology panel convened to develop a focused update of the American Society of Clinical Oncology guideline concerning use of postmastectomy radiotherapy (PMRT).
  
  
  METHODS
  A recent systematic literature review by Cancer Care Ontario provided the primary evidentiary basis. The joint panel also reviewed targeted literature searches to identify new, potentially practice-changing data.
  
  
  CONCLUSIONS
  The panel unanimously agreed that available evidence shows that PMRT reduces the risks of locoregional failure (LRF), any recurrence, and breast cancer mortality for patients with T1-2 breast cancer with one to three positive axillary nodes. However, some subsets of these patients are likely to have such a low risk of LRF that the absolute benefit of PMRT is outweighed by its potential toxicities. In addition, the acceptable ratio of benefit to toxicity varies among patients and physicians. Thus, the decision to recommend PMRT requires a great deal of clinical judgment. The panel agreed clinicians making such recommendations for individual patients should consider factors that may decrease the risk of LRF, attenuate the benefit of reduced breast cancer-specific mortality, and/or increase risk of complications resulting from PMRT. When clinicians and patients elect to omit axillary dissection after a positive sentinel node biopsy, the panel recommends that these patients receive PMRT only if there is already sufficient information to justify its use without needing to know additional axillary nodes are involved. Patients with axillary nodal involvement after neoadjuvant systemic therapy should receive PMRT. The panel recommends treatment generally be administered to both the internal mammary nodes and the supraclavicular-axillary apical nodes in addition to the chest wall or reconstructed breast.
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Abram
authors.initials: A
authors.lastname: Recht
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Comen
authors.affiliation: West Clinic Comprehensive Breast Center, Germantown, TN.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Fine
authors.affiliation: University of Chicago Medical Center, Chicago, IL.
authors.forename: Gini F
authors.initials: GF
authors.lastname: Fleming
authors.affiliation: Shaw Regional Cancer Center, Edwards, CO.
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Hardenbergh
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York.
authors.forename: Alice Y
authors.initials: AY
authors.lastname: Ho
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York.
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Hudis
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: E Shelley
authors.initials: ES
authors.lastname: Hwang
authors.affiliation: Hematology Oncology Associates of Central New York, East Syracuse.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Kirshner
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York.
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Kilian E
authors.initials: KE
authors.lastname: Salerno
authors.affiliation: Stanford University Medical Center, Palo Alto, CA.
authors.forename: George W
authors.initials: GW
authors.lastname: Sledge
authors.affiliation: Albert Einstein Healthcare Network, Philadelphia, PA.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Solin
authors.affiliation: North Carolina State University, Raleigh, NC.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Spears
authors.affiliation: Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Whelan
authors.affiliation: American Society of Clinical Oncology, Alexandria, VA. Electronic address: mark.somerfield@asco.org.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Somerfield
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Edge
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008495:Medical Oncology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D018787:Radiation Oncology; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy; D012955:Societies, Medical; D000071077:Surgical Oncology; D014481:United States