Evandro de Azambuja, President of the Belgian Society of Medical Oncology (BSMO) for 2023-2026, shared on LinkedIn:
“Does postmastectomy radiotherapy (PMRT) still matter in HER2-positive early breast cancer in the era of anti-HER2 therapy?
A new analysis of over 4,100 patients from the ALTTO trial provides important insights.
Patients with ≥4 positive lymph nodes (pN2) experienced significant benefits from PMRT, including:
- Better locoregional control
- Reduced distant recurrence
- Improved disease-free survival
- Improved overall survival
For patients with 1–3 positive nodes (pN1), the benefit was much less clear, with only a modest trend toward improved disease-free survival and no significant improvement in locoregional control, distant recurrence, or overall survival.
Node-negative (pN0) patients showed no evidence of benefit from PMRT.
These findings reinforce the role of PMRT in patients with a high nodal burden, while highlighting the need for prospective studies to better identify which patients with limited nodal involvement truly benefit in the era of highly effective HER2-targeted therapies.
As we continue to personalize local treatment and embrace axillary de-escalation, optimizing the use of radiotherapy remains a key research priority.”
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