ALEXANDRIA, Va, ARLINGTON, Va, ROSEMONT, Ill., September 19, 2016 Three leading national cancer organizations today issued a joint clinical practice guideline update for physicians treating women with breast cancer who have undergone a mastectomy. The update provides additional considerations for physicians to determine which patients might benefit from postmastectomy radiotherapy (PMRT).

“We still don’t have a single, validated formula that can determine who needs PMRT, but we hope that the research evidence summarized in this guideline update will help doctors and patients make more informed decisions,” said Stephen B. Edge, MD, co-chair of the Expert Panel that developed the guideline update. “We also hope that this publication will spur more research into patient and tumor characteristics that predict risk of recurrence after mastectomy.”

The American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO) together published the new guideline update in their respective journals, the Journal of Clinical Oncology, Practical Radiation Oncology and Annals of Surgical Oncology.
“In an era of personalized medicine, we want to be sure that we offer the right care to the right patients. Thanks to advances in systemic therapy, fewer women need radiation therapy after a mastectomy,” said Abram Recht, MD, co-chair of the Expert Panel that developed the guideline update. “This means we can be more selective when recommending this treatment to our patients.”

The guideline update states that there is strong evidence showing that PMRT reduces the risk of breast cancer recurrence. It provides evidence-based recommendations for the use of postmastectomy radiotherapy in: patients with T1-2 tumors (tumors smaller than 5 cm) and 1 to 3 positive lymph nodes; patients undergoing neoadjuvant systemic therapy (NAST); and patients with T1-2 tumors and a positive sentinel node biopsy. The Expert Panel also addressed technical aspects of radiotherapy, such as the optimal extent of regional nodal irradiation (RNI).

“For many women, PMRT reduces the risk of local and regional failure, but physicians must weigh this benefit with the considerable side effects associated with this treatment,” said Bruce G. Haffty, MD, immediate past chair of ASTRO’s Board of Directors. “This cooperative guideline underscores the complexity inherent in decisions related to PMRT, as well as the importance of clinical judgment in treatment planning.”

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