Skip to main content
SpringerLink
Log in
Book cover

Breast Disease pp 187–198Cite as

Post-Mastectomy Adjuvant Radiotherapy (PMRT)

  • Chapter
  • First Online:

  • 883 Accesses

Abstract

Mastectomy can remove any detectable macroscopic disease, but some tumor foci might remain in the locoregional tissue (i.e., chest wall or lymph nodes) that could lead the locoregional recurrence (LRR) of the disease. Post-mastectomy adjuvant radiotherapy (PMRT) has potential to eliminate such microscopic disease. The risk of LRR after mastectomy is 3–46%, depending on the stage of the disease and prognostic factors. PMRT has been recommended for patients with ≥4 positive axillary lymph nodes but not given for most women with node-negative disease. Patients with one to three positive axillary lymph nodes constitute a gray zone. PMRT indications and side effects will be discussed in this chapter.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Ceiley E, Jagsi R, Goldberg S, Grigon L, Kachnic L, Powell S, et al. Radiotherapy for invasive breast cancer in North America and Europe: results of a survey. Int J Radiat Oncol Biol Phys. 2005;61:365–73.

    Article  Google Scholar 

  2. Overgaard M, Hansen PS, Rose C, Andersson M, Kamby C. Postoperative radiotherapy in high risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group DBCCG 82b trial. N Engl J Med. 1997;337:949–55.

    Article  CAS  PubMed  Google Scholar 

  3. Overgaard M, Jensen MB, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high risk postmenopausal breast cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCCG 82c randomised trial. Lancet. 1999;353:1641–8.

    Article  CAS  PubMed  Google Scholar 

  4. Ragaz J, Jacson SM, Le N, Plenderleith IH, Spinelli JJ, Bosco VE, et al. Adjuvant radiotherapy and chemotherapy in node positive women with breast cancer. N Engl J Med. 1997;337:956–62.

    Article  CAS  PubMed  Google Scholar 

  5. Cuzick J, Stewart H, Peto R, Fisher B, Kaae S, Johansen H, et al. Overview of randomised trials comparing radical mastectomy without radiation therapy against simple mastectomy with radiation therapy in breast cancer. Cancer Treat Rep. 1987;71:7–14.

    CAS  PubMed  Google Scholar 

  6. McCammon R, Finlayson C, Schwer A, Rabinovitch R. Impact of postmastectomy radiotherapy in T3N0 invasive carcinoma of the breast: a surveillance, epidemiology, and end results database analysis. Cancer. 2008;1113(4):683–9.

    Article  Google Scholar 

  7. Recht A, Gray R, Davidson N, Fowble BL, Solin LJ, Cummings FJ, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol. 1999;17:1689–700.

    Article  CAS  PubMed  Google Scholar 

  8. Giuliano AE, Edge SB, Hortobagyi GN. Eighth edition of the AJCC cancer staging manual: breast cancer. Ann Surg Oncol. https://doi.org/10.1245/sl10434-018-6486-6.

  9. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of randomised trials. Lancet. 2005;366:2087–106.

    Article  CAS  PubMed  Google Scholar 

  10. Carey LA, Perou CM, Livasy CA, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 2006;295(21):2492–502.

    Article  CAS  PubMed  Google Scholar 

  11. Dent R, Trudeau M, Pritchard KI, et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 2007;13(15 pt 1):4429–34.

    Article  PubMed  Google Scholar 

  12. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual data for 10.801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.

    Article  Google Scholar 

  13. Eiermann W, Vallis KA. Locoregional treatments for triple-negative breast cancer. Ann Oncol. 2012;23(suppl 6):vi30–4.

    Article  PubMed  Google Scholar 

  14. Chen X, Xia F, Luo J, Ma J, Yang Z, Zhang L. Postmastectomy radiotherapy reduces locoregional and disease recurrence in patients with stage II-III triple-negative breast cancer treated with neoadjuvant chemotherapy and mastectomy. OncoTargets Ther. 2018;11:1973–80.

    Article  Google Scholar 

  15. Kong M, Hong S. Which patients might benefit from postmastectomy radiotherapy in breast cancer patients with T1–T2 tumor and 1–3 axillary lymph node metastasis? Cancer Res Treat. 2013;45(2):103–11.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gabos Z, Thoms J, Ghosh S, et al. The association between biological subtype and locoregional recurrence in newly diagnosed breast cancer. Breast Cancer Res Treat. 2010;124(1):187–94.

    Article  PubMed  Google Scholar 

  17. Wang J, Shi M, Ling R, et al. Adjuvant chemotherapy and radiotherapy in triple-negative breast carcinoma: a prospective randomized controlled multi-center trial. Radiother Oncol. 2011;100(2):200–4.

    Article  CAS  PubMed  Google Scholar 

  18. Jagsi R, Raad RA, Goldberg S, et al. Locoregional recurrence rates and prognostic factors for failure in node- negative patients treated with mastectomy: implications for postmastectomy radiation. Int J Radiat Oncol Biol Phys. 2005;62(4):1035–9.

    Article  PubMed  Google Scholar 

  19. Truong PT, Lesperance M, Culhaci A, Kader HA, Speers CH, Olivotto IA. Patient subsets with T1–T2, node-negative breast cancer at high locoregional recurrence risk after mastectomy. Int J Radiat Oncol Biol Phys. 2005;62(1):175–82.

    Article  PubMed  Google Scholar 

  20. Abdulkarim BS, Cuartero J, Hanson J, Deschenes J, Lesniak D, Sabri S. Increased risk of locoregional recurrence for women with T1–T2N0 triple- negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast conserving therapy. J Clin Oncol. 2011;29(21):2852–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Selz J, Stevens D, Jouanneau L, Labib A, Le Scodan R. Prognostic value of molecular subtypes, Ki-67 expression and impact of postmastectomy radiation therapy in breast cancer patients with negative lymph nodes after mastectomy. Int J Radiat Oncol Biol Phys. 2012;84:1123–32.

    Article  CAS  PubMed  Google Scholar 

  22. Gren FL. The American joint committee on cancer: updating the strategies in cancer staging. Bull Am Coll Surg. 2002;87:13–5.

    Google Scholar 

  23. Taghian AG, Jeong JH, Mamounas EP, Parda DS, Deutsch M, et al. Low locoregional recurrence rate among node-negative breast cancer patients with tumor 5 cm or larger treated by mastectomy, with or without adjuvant systemic therapy and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol. 2006;24:3927–32.

    Article  PubMed  Google Scholar 

  24. Goulart J, Truong P, Woods R, Speers CH, Kennecke H, Nichol A, et al. Outcomes of node- negative breast cancer 5 centimeters and larger treated with and without postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys. 2011;80:758–64.

    Article  PubMed  Google Scholar 

  25. Killander F, Anderson H, Ryden S, Möller T, Hafström LO, Malmström P, et al. Efficient reduction of locoregional recurrences but no effect on mortality twenty years after postmastectomy radiation in premenopausal women with stage II breast cancer- a randomized trial from the South Sweden Breast Cancer Group. Breast. 2009;18:309–15.

    Article  PubMed  Google Scholar 

  26. Floyd SR, Bucholz TA, Haffty BG, Goldberg S, Niemierko A, Road RA, et al. Low local recurrence rate without postmastectomy radiation in node- negative breast cancer patients with tumors 5 cm and larger. Int J Radiat Oncol Biol Phys. 2006;66(2):358–64.

    Article  PubMed  Google Scholar 

  27. Cutter D, Duane F, Ewertz M, Gray G, McGale P, Taylor C, Correa C, EBCTCG (Early Breast Cancer Trialists’ Collaborative Group). Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality; meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383:2127–35.

    Article  PubMed  Google Scholar 

  28. Theriault RL, Goldstein LJ, Pierce LJ, Carlson RW, Gradishar WJ, Reed EJ, Panel Members. National Comprehensive Cancer Network. NCCN breast cancer clinical practice guidelines in oncology. 2.2013. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf. Accessed Jan 2013.

  29. National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology: breast cancer. Ver.1.2019. www.nccn.org.

  30. Gradishar W, Giordano SH, Pierce LJ, Anderson BO, Goetz M, Reed EC, Panel Members. National Comprehensive Cancer Network. NCCN breast cancer clinical practice guidelines in oncology. 2.2015. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf. Accessed 3 Nov 2015.

  31. Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thürlimann B, Senn HJ, Panel members. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol. 2013;24(9):2206–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Hojris I, Overgaard M, Christensen JJ, Overgaard J. Morbidity and mortality of ischaemic hard disease in high-risk breast cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials. Lancet. 1999;354:1425–30.

    Article  CAS  PubMed  Google Scholar 

  33. Early Breast Cancer Trialists Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet. 2000;355:1757–70.

    Article  Google Scholar 

  34. Van De Steene J, Soete G, Storme G. Adjuvant radiotherapy for breast cancer significantly improves overall survival: the missing link. Radiother Oncol. 2000;55(3):263–172.

    Article  PubMed  Google Scholar 

  35. Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML. Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol. 2000;18:1220–9.

    Article  CAS  PubMed  Google Scholar 

  36. Chung CS, Harris JR. Postmastectomy radiation therapy: translating local benefits into improved survival. Breast. 2007;16:78–83.

    Article  Google Scholar 

  37. Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson K, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst. 2005;97:116–26.

    Article  PubMed  Google Scholar 

  38. Overgaard M, Nielsen HM, Overgaard J. Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A sub-group analysis of the DBCG 82b&c randomised trials. Radiother Oncol. 2007;82:247–53.

    Article  PubMed  Google Scholar 

  39. Danforth DN, Findlay PA, McDonald HD, Lippman ME, Reichert LM, d’Angelo T, et al. Complete axillary lymph node dissection for stage I–II carcinoma of the breast. J Clin Oncol. 1986;4:655–62.

    Article  PubMed  Google Scholar 

  40. Saha S, Farrar WB, Young DC, Ferrara JJ, Burak WE Jr, et al. Variation in axillary node dissection influences the degree of nodal involvement in breast cancer patients. J Surg Oncol. 2000;73:134–7.

    Article  CAS  PubMed  Google Scholar 

  41. Katz A, Strom EA, Buchholz TA, Thames HD, Smith CD, Jhingran A, et al. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol. 2000;18:2817–27.

    Article  CAS  PubMed  Google Scholar 

  42. Taghian AG, Jeong JH, Mamounas E, Anderson S, Bryant J, Deutsch M, et al. Pattern of locoregional and distant failure in patients with breast cancer treated with mastectomy and chemotherapy with or without tamoxifen without radiation: results from five NSABP randomized trials. J Clin Oncol. 2004;22(21):4247–54. Epub 2004 Sep 27.

    Article  PubMed  Google Scholar 

  43. Katz A, Storm EA, Buchholz TA, Theriault R, Singletary SE, Mc Neese MD, et al. The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy. Int J Radiat Oncol Biol Phys. 2001;50:735–42.

    Article  CAS  PubMed  Google Scholar 

  44. Sharma R, Bedrosian I, Lucci A, Hwang RF, Rourke LL, Qiao W, et al. Present day locoregional control in patients with T1 or T2 breast cancer with 0 and 1 to 3 positive lymph nodes after mastectomy without radiotherapy. Ann Surg Oncol. 2010;17:2899–908.

    Article  PubMed  PubMed Central  Google Scholar 

  45. EBCTCG. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15 – year survival: an overview of the randomised trials. Lancet. 2005;365:1687–777.

    Article  CAS  Google Scholar 

  46. Coates AS, Keshaviah A, Thurlimann B, Mouridsen H, Mauriac LL, Forbes JF, et al. Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine – responsive early breast cancer: update of study BIG 1–98. J Clin Oncol. 2007;25:486–92.

    Article  CAS  PubMed  Google Scholar 

  47. Coombes RC, Kilborn LS, Snowdon CF, Paridaens R, Coleman RE, Jones SE, et al. Survival and safety of exemestane versus tamoxifen after 2–3 years tamoxifen treatment (Intergroup Exemestane Study): a randomized controlled trial. Lancet. 2007;369:359–70.

    Google Scholar 

  48. Forbes JF, Cuzick J, Buzdar A, Howell A, Tobias JS, Baum M. Effect of anastrozole and tamoxifen as adjuvant treatment for early stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol. 2008;9:45–53.

    Article  PubMed  CAS  Google Scholar 

  49. Goss PE, Ingle JN, Martino S, Robert NJ, Muss HB, Piccart MJ, et al. Efficacy of letrozole extended adjuvant therapy according to estrogen receptor and progesterone receptor status of the primary tumor: National Cancer Instıtute of Canada Clinical Trials Group MA.17. J Clin Oncol. 2007;25:2006–11.

    Article  CAS  PubMed  Google Scholar 

  50. Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE, et al. Trastuzumab plus adjuvant chemotherapy for operable HER-2 positive breast cancer. N Engl J Med. 2005;353:1673–84.

    Article  CAS  PubMed  Google Scholar 

  51. Thürlimann B, Keshaviah A, Coates AS, Mouridsen H, Mauriac L, Forbes JF, et al. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med. 2005;353:2747–57.

    Article  PubMed  Google Scholar 

  52. Ward S, Simpson E, Davis S, Hind D, Rees A, Wilinson A, et al. Taxanes fort the adjuvant treatment of early breast cancer: systematic review and economic evaluation. Health Technol Assess. 2007;11:1–144.

    PubMed  Google Scholar 

  53. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100 000 women in 123 randomised trials. Lancet. 2012;379:432–44.

    Article  CAS  Google Scholar 

  54. Qin YY, Li H, Guo XJ, Yex F, Wei X, Zhou YH, et al. Adjuvant chemotherapy, with or without taxanes, in early or operable breast cancer: a meta-analysis of 19 randomized trials with 30698 patients. PLoS One. 2011;6:1–11.

    Google Scholar 

  55. Kyndi M, Sorensen FB, Knudsen H, Overgaard M, Nielsen HM, Overgaard J. Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high risk breast cancer. The Danish Breast Cancer Cooperative Group. J Clin Oncol. 2008;26:1419–26.

    Article  CAS  PubMed  Google Scholar 

  56. Kyndi M, Overgaard M, Nielsen HM, Sorenson FB, Knudsen H, Overgaard J. High local recurrence risk is not associated with large survival reduction after postmastectomy radiotherapy in high risk breast cancer: a subgroup analysis of DBCG 82b&c. Radiother Oncol. 2009;90:74–9.

    Article  PubMed  Google Scholar 

  57. Kyndi M, Sorensen FB, Knudsen H, Overgaard M, Nielsen HM, Anderson J, et al. Impact of BCL2 and p53 on postmastectomy radiotherapy response in high risk breast cancer. A subgroup analysis of DBCG82 b&c. Acta Oncol. 2008;47:608–17.

    Article  CAS  PubMed  Google Scholar 

  58. Truong PT, Olivotto IA, Kader HA, Panades M, Speers CH, Berthelet E, et al. Selecting breast cancer patients with T1–T2 tumors and one to three positive axillary nodes at high postmastectomy locoregional recurrence risk for adjuvant radiotherapy. Int J Radiat Oncol Biol Phys. 2005;61(5):1337–47.

    Article  PubMed  Google Scholar 

  59. Gebski V, Lagleva M, Keech A, Sims J, Langlands AO. Survival effects of postmastectomy adjuvant radiation therapy using biologically equivalent doses. J Natl Cancer Inst. 2006;98:26–38.

    Article  PubMed  Google Scholar 

  60. Demirci S, Nam J, Hubbs J, Thu Nguyen BA, Marks LB. Radiation induced cardiac toxicity after therapy for breast cancer: interaction between treatment era and follow-up duration. Int J Radiat Oncol Biol Phys. 2009;73:980–7.

    Article  PubMed  Google Scholar 

  61. Darby S, McGale P, Peto R, Granath F, Hall P, Ekbom A. Mortality from cardiovascular disease more than 10 years after radiotherapy for breast cancer: nationwide cohort study of 90 000 Swedish women. BMJ. 2003;326:256–7.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Harris EE, Correa C, Hwang WT, Liao J, Litt HI, Ferrari VA, et al. Late cardiac mortality and morbidity in early-stage breast cancer patients after breast conservation treatment. J Clin Oncol. 2006;24:4100–6.

    Article  PubMed  Google Scholar 

  63. Giordano SH, Kuo YF, Freeman JL, Bucholz TA, Hortobagyi GN, Goodwin JS. Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst. 2005;97:419–24.

    Article  PubMed  Google Scholar 

  64. Hooning MJ, Aleman BM, van Rosmalen AJ, Kuenen MA, Klijn JG, van Leeuwen FE. Cause-specific mortality in long-term survivors of breast cancer: a 25-year follow-up study. Int J Radiat Oncol Biol Phys. 2006;64:1081–91.

    Article  PubMed  Google Scholar 

  65. Hooning MJ, Botma A, Aleman BM, Baaijens MH, Bartelink H, Klijn JG, et al. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst. 2007;99:365–75.

    Article  PubMed  Google Scholar 

  66. Recht A, Edge SB, Solin LJ, Robinson DS, Estabrook A, Fine RE, et al. Postmastectomy radiotherapy: clinical practice guidelines of American Society of Clinical Oncology. J Clin Oncol. 2001;19:1539–69.

    Article  CAS  PubMed  Google Scholar 

  67. Harris JR, Halpin-Murphy P, McNeese M, Mendenhall NP, Morrow M, Robert NJ. Consensus statement on postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys. 1999;44:989–90.

    Article  CAS  PubMed  Google Scholar 

  68. Goldhirsch A, Ingle JN, Gelber RD, Coates AS, Thürlimann B, Senn HJ, Panel Members. Thresholds for therapies: highlights of the St Galen International Expert Consensus on the primary therapy of early breast cancer 2009. Ann Oncol. 2009;20:1319–29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Crugliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, et al. De – escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus conference on the primary therapy of early breast cancer 2017. Ann Oncol. 2017;28:1700–12.

    Article  Google Scholar 

  70. Sautter-Bihl ML, Souchon R, Budach W, Sedlmayer F, Feyer M, Harm W, Haase W. DEGRO practical guidelines for radiotherapy of breast cancer II. Postmastectomy radiotherapy, irradiation of regional lymphatics, and treatment of locally advanced disease. Strahlenther Onkol. 2008;184:347–53.

    Article  PubMed  Google Scholar 

  71. Wenz F, Sperk E, Budach W, Dunst J, Feyer P, Feitkau R, et al. DEGRO practical guidelines for radiotherapy of breast cancer IV. Radiotherapy following mastectomy for invasive breast cancer. Strahlenther Onkol. 2014;190:705–14.

    Article  PubMed  Google Scholar 

  72. Recht A, Comen EA, Fine ER, Fleming GF, Hardenbergh PH, Ho AY, et al. Postmastectomy radiotherapy: an American society of clinical oncology, American society for radiation oncology, and society of surgical oncology focused guideline update. JCO. 2016; https://doi.org/10.1200/JCO.2016.69.1188.

    Article  PubMed  Google Scholar 

  73. McBride A, Allen P, Woodward W, Kim M, Kuerer HM, Drinka EK, et al. Locoregional recurrence risk for patients with T1,2 breast cancer with 1–3 lymph nodes treated with mastectomy and systemic treatment. Int J Radiat Oncol Biol Phys. 2014;89:392–8.

    Article  PubMed  Google Scholar 

  74. Poortmans PM, Collette S, Kirkove C, Limbergen VE, Budach V, Struikmans H, et al. EORTC radiation oncology and breast cancer groups. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373:317–27.

    Article  CAS  PubMed  Google Scholar 

  75. Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, MA.20 Study Investigators, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373:307–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Hennequin C, Bossard N, Vernat-Servagi S, Maingon P, Dubois JB, Carrie C, et al. Ten-year results of a randomized trial of irradiation internal mammary nodes after mastectomy. Int J Radiat Oncol Biol Phys. 2013;86(5):860–6.

    Article  PubMed  Google Scholar 

  77. Stemmer SM, Riel S, Hardon I, Adamo A, Neumann A, Goffman J, et al. The role of irradiation of the internal mammary nodes in high risk stage II to IIIA breast cancer patients after high dose chemotherapy: a prospective sequential non randomized study. J Clin Oncol. 2003;21:2713–8.

    Article  PubMed  Google Scholar 

  78. Obedion E, Haffty BG. Internal mammary nodal irradiation in conservatively managed breast cancer patients: is there a benefit? Int J Radiat Oncol Biol Phys. 1994;44:997–1003.

    Article  Google Scholar 

  79. Anderson WF, Chu KC, Chang S. Inflammatory breast carcinoma and noninflammatory locally advanced breast carcinoma: distinct clinicopathologic entities. J Clin Oncol. 2003;21:2254–9.

    Article  PubMed  Google Scholar 

  80. Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, Dhingra K, et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 1999;17:460–9.

    Article  CAS  PubMed  Google Scholar 

  81. Kuerer HM, Sahin AA, Hunt KK, Newman LA, Breslin T, Ames FC, et al. Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with neoadjuvant chemotherapy. Ann Surg. 1999;230:72–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1997;15:2483–93.

    Article  CAS  PubMed  Google Scholar 

  83. Rastgoli P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, Robidoux A, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol. 2008;26:778–85.

    Article  Google Scholar 

  84. Van der Hage JA, van de Velde CJ, Julien JP, Tubiana-Hulin M, Vandervelden C, Duchateau L, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European organization for research and treatment of cancer trial 10902. J Clin Oncol. 2001;19:4224–37.

    Article  PubMed  Google Scholar 

  85. Piccart MJ, DE Valeriola D, Paridaens R, Balikdjian D, Mattheiem WH, Loriaux C, et al. Six year results of a multimodality treatment strategy for locally advanced breast cancer. Cancer. 1988;62:2501–6.

    Article  CAS  PubMed  Google Scholar 

  86. Bedwinek J, Rao DV, Perez C, Lee J, Fineberg B. Stage II–I and localized stage IV breast cancer: irradiation alone versus irradiation plus surgery. Int J Radiat Oncol Biol Phys. 1982;8:31–6.

    Article  CAS  PubMed  Google Scholar 

  87. De Lena M, Varini M, Zucalli R, Rovini D, Viganotti G, Valagussa P, et al. Multimodal treatment for locally advanced breast cancer. Cancer Clin Trials. 1981;4:229–36.

    PubMed  Google Scholar 

  88. Kelfström P, Gröhn P, Heinonen E, Holsti L, Holsti P, et al. Adjuvant postoperative radiotherapy, chemotherapy and immunotherapy in stage III breast cancer. Cancer. 1987;60:936–42.

    Article  Google Scholar 

  89. Huang EH, Tucker SL, Strom EA, McNeese MD, Kuerer HM, Buzdar AU, et al. Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. J Clin Oncol. 2004;22:4691–9.

    Article  PubMed  Google Scholar 

  90. McGuire SE, Gonzales-Angulo AM, Huang EH, Tucker SL, Kau SW, Yu TK, et al. Postmastectomy radiation improves the outcome of patients with locally advanced breast cancer who achieve a pathologic complete response to neoadjuvant chemotherapy. Int J Radiat Oncol Biol Phys. 2007;68:1004–9.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Bae SH, Park W, Huh SJ, Choi DH, Nam SJ, Im YH, et al. Radiation treatment in pathologic N0–N1 patients treated with neoadjuvant chemotherapy followed by surgery for locally advanced breast cancer. J Breast Cancer. 2012;15(3):329–36. Epub2012 Sep 28. https://doi.org/10.4048/ibc.2012.15.3.329.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiation Oncology, Dokuz Eylül University, İzmir, Turkey

    Ilknur Bilkay Gorken

Authors
  1. Ilknur Bilkay Gorken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilknur Bilkay Gorken .

Editor information

Editors and Affiliations

  1. Oncology Institute, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Adnan Aydiner

  2. Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    Abdullah Igci

  3. Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee-Women’s Hospital of UPMC, Pittsburgh, PA, USA

    Atilla Soran

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gorken, I.B. (2019). Post-Mastectomy Adjuvant Radiotherapy (PMRT). In: Aydiner, A., Igci, A., Soran, A. (eds) Breast Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-16792-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16792-9_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16791-2

  • Online ISBN: 978-3-030-16792-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation