What are the ASCO guidelines for postmastectomy radiation therapy in the treatment of breast cancer?

Updated: Feb 04, 2021
  • Author: Pavani Chalasani, MD, MPH; Chief Editor: John V Kiluk, MD, FACS  more...
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Clinical practice guidelines developed by the American Society of Clinical Oncology (ASCO), recommend that postmastectomy radiation therapy be performed according to the following criteria [121] :

  • Positive postmastectomy margins
  • Primary tumors >5 cm
  • Involvement of ≥4 lymph nodes

Patients with more than four positive lymph nodes should also undergo prophylactic nodal radiation therapy at doses of 45-50 Gy to the axillary and supraclavicular regions. For patients in whom ALND shows no node involvement, axillary radiation therapy is not recommended.

For women with invasive breast cancer who receive whole-breast irradiation (WBI), updated guidelines from the American Society of Radiation Oncology (ASTRO) recommend the use of hypofractionated WBI regardless of patient age, chemotherapy history, or tumor stage. The 2018 update expands the indications for WBI; previous guidelines, from 2001, recommended the treatment for patients aged 50 and older whose disease was less advanced (T1–2, N0) and who had not undergone chemotherapy. For WBI with or without inclusion of the low axilla, the preferred scheme is hypofractionated WBI to a dose of 4000 cGy in 15 fractions or 4250 cGy in 16 fractions. [183]

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