To develop this guideline update, an Expert Panel reviewed relevant literature published between January 2001 and July 2015. This included a meta-analysis of 22 clinical trials published in 2014, which provides evidence that PMRT is highly effective at preventing local breast cancer recurrence.

Key recommendations of the guideline update are as follows:


Decision to use PMRT should involve providers from all treating disciplines as well as the patient. Doctors and patients should discuss risks and benefits to determine the best treatment approach for the patient.
For women with T1-2 breast cancer and 1-3 positive lymph nodes, PMRT reduces the risk of recurrence and breast cancer death. However, for some patients with a low risk of recurrence, the potential complications of PMRT may outweigh the benefit.

When making decisions on recommending PMRT, doctors should consider patient and tumor characteristics that may diminish the benefit of PMRT or increase the risk of complications.

Patients with T1-2 tumors with a positive sentinel node biopsy who elect to omit axillary lymph node dissection should receive PMRT only if there is already sufficient information to justify its use without needing to know that additional axillary nodes are involved.

Patients with axillary nodal involvement that persists following neoadjuvant systemic therapy should receive PMRT.

Radiation should generally be given to both the internal mammary nodes and the supraclavicular-axillary apical nodes in addition to the chest wall or reconstructed breast when PMRT is used for patients with positive axillary lymph nodes.

“This guideline highlights the need to individualize therapy as well as identifies areas where more research is needed,” said Monica Morrow, MD, FACS, the SSO representative on the Expert Panel that developed the guideline update. “It emphasizes that we are moving beyond a simplistic one size fits all approach to more tailored therapy which will improve benefits for patients.”

View the complete guideline in the following journals:


ABOUT ASCO
Founded in 1964, the American Society of Clinical Oncology (ASCO) is committed to making a world of difference in cancer care. As the world's leading organization of its kind, ASCO represents more than 40,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of the highest-quality patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation. Learn more at www.ASCO.org, explore patient education resources at www.Cancer.Net, and follow us on Facebook, Twitter, LinkedIn, and YouTube.

Rad Oncology Homepage