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ASCO/ASTRO/SSO Update Guidelines on Postmastectomy RT

Clear evidence that PMRT benefit extends to women with limited lymph node involvement

WEDNESDAY, Sept. 21, 2016 (HealthDay News) — New guidelines have been issued by three leading cancer organizations for postmastectomy radiotherapy (PMRT). All three groups published the guidelines online this week in their respective journals: the Journal of Clinical Oncology, Practical Radiation Oncology, and the Annals of Surgical Oncology.

The guidelines state that there is clear evidence for PMRT reducing the risks of locoregional failure (LRF), any recurrence, and breast cancer mortality in women with T1-2 breast cancer and one to three positive axillary nodes. “The new guidelines say there is clear evidence that the benefit of PMRT extends to women with limited lymph node involvement,” Stephen Edge, M.D., vice president for health care outcomes and policy at the Roswell Park Cancer Institute in Buffalo, N.Y., told HealthDay. Edge was co-chair of the panel that developed the new guidelines.

“However, some subsets of these patients are likely to have such a low risk of LRF that the absolute benefit of PMRT is outweighed by its potential toxicities,” the authors write. “In addition, the acceptable ratio of benefit to toxicity varies among patients and physicians. Thus, the decision to recommend PMRT requires a great deal of clinical judgment.”

The guidelines also provide evidence-based recommendations for use of PMRT in patients undergoing neoadjuvant systemic therapy, and patients with T1-2 tumors and a positive sentinel node biopsy. Technical aspects of radiotherapy, such as the optimal extent of regional nodal irradiation, are also addressed.

Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.

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