Guidelines Developed for Postmastectomy Radiation Therapy
THURSDAY, Sept. 25, 2025 -- In a clinical practice guideline published online Sept. 16 in Practical Radiation Oncology, recommendations are presented for the use of postmastectomy radiation therapy (PMRT).
Rachel B. Jimenez, M.D., from Massachusetts General Hospital in Boston, and colleagues convened a multidisciplinary task force to address four questions focused on radiation therapy in patients with breast cancer who undergo mastectomy.
The authors noted that PMRT is indicated for most patients with node-positive breast cancer and select patients with node-negative disease after upfront mastectomy. For patients presenting with locally advanced disease and for those with residual nodal disease at the time of surgery, PMRT is also recommended after neoadjuvant systemic therapy. For patients with cT1-3N1 or cT3N0 breast cancer with pathologically negative nodes after neoadjuvant systemic therapy, PMRT is conditionally recommended. Treatment to the ipsilateral chest wall/reconstructed breast and regional lymphatics is recommended when PMRT is delivered, with moderate hypofractionation preferred; in rare cases, conventional fractionation approaches are acceptable. There is a recommendation for computed tomography-based volumetric treatment planning with three-dimensional conformal RT; when three-dimensional conformal RT is unable to achieve treatment goals, intensity-modulated RT is advised. For normal tissue sparing, deep inspiration breath-hold techniques are recommended. The use of a bolus is recommended for patients with skin involvement, positive superficial margins, and/or lymphovascular invasion; routine use of a tissue-equivalent bolus is not recommended.
"The benefit of PMRT depends on a patient's disease characteristics and personal preferences, which is why evidence-based, individualized decisions are so important," Jimenez said in a statement.
Several authors disclosed ties to industry.
Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.
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