Postmastectomy radiation: an evolution

Abstract

: Postmastectomy radiation therapy (PMRT) has long been utilized to improve locoregional control versus surgery alone, and recent decades have revealed a survival benefit for many higher risk patients based on tumor or nodal factors. During this time the landscape of cancer treatment has evolved towards less invasive surgeries and more effective chemotherapy—likewise, more precise methods of delivering radiation therapy have also emerged, drastically reducing the risk for significant side effects compared with cruder historical techniques. This paper will discuss modern era radiation techniques, toxicity profile, and reconstructive options. Several recent studies have demonstrated improved locoregional control and overall survival in patients whom received postmastectomy radiation. This review will pay special attention to utility of radiation after mastectomy in patients with positive nodes and negative nodes with high-risk features. The indications for radiation therapy after mastectomy have broadened over the past few decades and this review article hopes to explore evolving evidence, as well as, new considerations in setting of increasing use of neoadjuvant chemotherapy and trend towards shorter course radiation treatment. Future directions and ongoing trials exploring benefit of additional radiation and omission of radiation will also be discussed. While some questions remain unanswered on exactly who is likely to benefit, anyone with a large tumor, nodal involvement or other high-risk features should be considered for evaluation.