Controversies Regarding the Use of Radiation After Mastectomy in Breast Cancer

Abstract

Abstract Learning Objectives After completing this course, the reader will be able to:Explain the potential benefits of delivering radiation after mastectomy for patients with breast cancer.Provide a list of appropriate indications for selecting which patients would benefit from radiation after mastectomy and chemotherapy.Appreciate how radiation can potentially cause cardiovascular injuries and understand the importance of radiation technique in minimizing the risk for such injuries.Appreciate how immediate breast reconstruction can affect the delivery of postmastectomy radiation. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com Despite years of clinical study, there are still many unanswered questions regarding postmastectomy radiation. It is clear that radiation therapy plays a critical role in the multidisciplinary management of patients with locally advanced or inflammatory breast cancer. It is also accepted that postmastectomy radiation is not required for most women with noninvasive disease or stage I disease. Randomized clinical trials studying radiation treatments for women with stage II or III breast cancer have shown that the addition of radiation after mastectomy can reduce local-regional recurrence rates, which then improves survival. However, other data have indicated that the risk of local-regional recurrence after mastectomy and chemotherapy is low for patients with small tumors and one to three positive lymph nodes, leading some to question whether postmastectomy radiation is useful for this group. A second controversy regards the sequencing of postmastectomy radiation and breast reconstruction. In this article we discuss these controversies, review the data that are relevant, and provide our institutional approaches to these issues.