Evidence-based indications for postmastectomy irradiation

It has long been controversial whether postmastectomy irradiation (PMRT) decreases the risks of distant failure and death due to cancer. This article reviews portions of the evidence-based guidelines for PMRT created by the American Society of Clinical Oncology and published in 2001. PMRT was indicated routinely for patients with four or more positive axillary nodes, with tumors larger than 5 cm, or with locally advanced cancers. There was insufficient evidence to make recommendations for the use of PMRT for patient with T1-2 tumors with one to three positive axillary nodes, or for all patients receiving neoadjuvant systemic therapy. Physicians and patients are encouraged to participate in randomized trials exploring such issues, such as the ongoing intergroup study for patients with one to three positive axillary nodes.