ABSTRACT

1997 has been a turning point for the indication of post-mastectomy radiation therapy (PMRT). Two randomized studies from Denmark and British Columbia showed 9% absolute improvement in overall survival, in addition to local control with the use of PMRT in patients with tumors greater than 5 cm and/or lymph node metastases. Several meta-analyses followed these publications all showing improvement in local control and indicating survival advantage with the use of radiotherapy in breast cancer. Contraversy was on the issue of whether radiotherapy should be used in all post-mastectomy patients or only on moderate to high (such as 10-20% or higher) local recurrence risk patients. Most consensus statements and all guidelines report that, high local recurrence risk patients, such as those with more than 4 involved nodes, T3N+, T4 or those with positive surgical margins are candidates for PMRT. T1/T2 N1-3+ patients are not in this category. However, in some analyses an improvement in local control and in survival with the use of radiotherapy has also been shown in patients with even one lymph node metastasis. This article will discuss the PMRT indication in 1-3 node positive patients. The reasons for these discussions are, the diffi culty of showing the benefi ts of radiotherapy in low risk patients and the wish of avoiding major radiation therapy related complications. One cruical issue in this indication is to use precise radiotherapy techniques in order to protect as much normal tissue as possible.