TITLE

Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy

AUTHOR(S)
Truong, Pauline T.; Olivotto, Ivo A.; Whelan, Timothy J.; Levine, Mark
PUB. DATE
April 2004
SOURCE
CMAJ: Canadian Medical Association Journal;4/13/2004, Vol. 170 Issue 8, p1263
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective: To provide information and recommendations to assist women with breast cancer and their physicians in making de-cisions regarding the use of locoregional post-mastectomy ra-diotherapy (PMRT). Outcomes: Locoregional control, disease-free survival, overall survival and treatment-related toxicities. Evidence: This guideline is based on a review of all meta-analyses, consensus statements and other guidelines published between 1966 and November 2002. Searches of MEDLINE and CAN-CERLIT for English-language randomized controlled trials pub-lished between 1995 and November 2002 were also con-ducted to supplement the literature previously reviewed by the American Society of Clinical Oncology (ASCO) Health Services Research Committee panel in its published guideline. A non-systematic review of the literature was continued through June 2003. Recommendations: Locoregional PMRT is recommended for women with an ad-vanced primary tumour (tumour size 5 cm or greater, or tu-mour invasion of the skin, pectoral muscle or chest wall). Locoregional PMRT is recommended for women with 4 or more positive axillary lymph nodes. The role of PMRT in women with 1 to 3 positive axillary lymph nodes is unclear. These women should be offered the opportunity to participate in clinical trials of PMRT. Locoregional PMRT is generally not recommended for women who have tumours that are less than 5 cm in diameter and who have negative axillary nodes. Other patient, tumour and treatment characteristics, including age, histologic grade, lymphovascular invasion, hormone re-ceptor status, number of axillary nodes removed, axillary ex-tracapsular extension and surgical margin status, may affect lo-coregional control, but their use in specifying additional indications for PMRT is currently unclear. PMRT should encompass the chest wall and the supraclavicu-lar, infraclavicular and axillary apical lymph node areas. To reduce the risk of lymphedema, ra...
ACCESSION #
12695670

 

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