Annals of Surgical Oncology

, Volume 25, Supplement 3, pp 659–660 | Cite as

ASO Author Reflections: The Role of Post-mastectomy Radiation Therapy in the Setting of Nodal Micrometastases

  • Naamit K. GerberEmail author
  • S. Peter Wu
ASO Author Reflections


The recently revised SSO/ASTRO/ASCO guidelines recommend consideration of post-mastectomy radiation therapy (PMRT) in patients with nodal macrometastasis in one to three axillary nodes to reduce the risk of breast cancer death and local recurrence.1 The benefit associated with PMRT in patients with nodal micrometastases is not well-studied. This is in part because the randomized trials that showed the benefit of PMRT did not classify patients as having micrometastases due to the methods of lymph node detection at the time these studies were performed. Further complicating this question is the increasing omission of axillary lymph node dissection (ALND) in the setting of a positive sentinel lymph node biopsy (SLNB) based on randomized trials, which exclusively or primarily were comprised of lumpectomy patients.2,3 In these trials, the vast majority of patients had lumpectomy and therefore received at least whole breast irradiation, if not additional nodal fields.4As such, these...



The author has no conflicts of interest to disclose.


  1. 1.
    Recht A, et al. Postmastectomy radiotherapy: an American society of clinical oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. Pract Radiat Oncol. 2016;6(6):e219–e234.CrossRefGoogle Scholar
  2. 2.
    Giuliano AE, et al. Effect of axillary dissection vs. no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA. 2017;318(10):918–926.CrossRefGoogle Scholar
  3. 3.
    Galimberti V, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23–01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297–305.CrossRefGoogle Scholar
  4. 4.
    Jagsi R, et al. Radiation field design in the ACOSOG Z0011 (Alliance) trial. J Clin Oncol. 2014;32(32):3600.CrossRefGoogle Scholar
  5. 5.
    Mamtani A, et al. Axillary micrometastases and isolated tumor cells are not an indication for post-mastectomy radiotherapy in stage 1 and 2 breast cancer. Ann Surg Oncol. 2017;24(8):2182–2188.CrossRefGoogle Scholar
  6. 6.
    FitzSullivan E. et al. Outcomes of sentinel lymph node-positive breast cancer patients treated with mastectomy without axillary therapy. Ann Surg Oncol. 2017;24(3):652–659.CrossRefGoogle Scholar
  7. 7.
    Wu SP, et al. Post-mastectomy radiation therapy in breast cancer patients with nodal micrometastases. Ann Surg Oncol. 2018;25(9):2620–26231.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Department of Radiation Oncology, Laura and Isaac Perlmutter Cancer CenterNYU Langone HealthNew YorkUSA

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