Kefah Mokbel, Professor of Medicine (Honorary) at Cardiff University School of Medicine, shared on LinkedIn:
“New ASTRO/ASCO/SSO Guidelines on Postmastectomy Radiation Therapy
The latest clinical practice guideline from ASTRO, ASCO, and SSO offers evidence-based recommendations on postmastectomy radiation therapy (PMRT) for breast cancer patients:
After upfront mastectomy, PMRT is indicated for most patients with node-positive breast cancer and select patients with node-negative disease. PMRT is also recommended after neoadjuvant systemic therapy, both for patients presenting with locally advanced disease and for those with residual nodal disease at the time of surgery.
PMRT is conditionally recommended for patients with cT1-3N1 or cT3N0 breast cancer with pathologically negative nodes after neoadjuvant systemic therapy (ypNO). When PMRT is delivered, treatment to the ipsilateral chest wall/reconstructed breast and regional lymphatics is recommended, with moderate hypofractionation preferred, but with conventional fractionation approaches acceptable in rare cases.
Computed tomography-based volumetric treatment planning with 3-dimensional conformal RT is recommended, with intensity modulated RT advised when 3-dimensional conformal RT is unable to achieve treatment goals. Deep inspiration breath hold techniques are also recommended for normal tissue sparing. For patients with skin involvement, positive superficial margins, and/or lymphovascular invasion, the use of a bolus is recommended, but the routine use of tissue-equivalent bolus is not recommended.”
More insights from Kefah Mokbel.