Practical consensus recommendations regarding role of postmastectomy radiation therapy

D. Singh; G. Saini; R. Koul; V. Gupta; D. Abrol; S. De; P. Kulshrestha; S. N. Hukku; S. J. Lakshmi; Purvish M. Parikh; S. Aggarwal

doi:10.4103/sajc.sajc_108_18

South Asian Journal of Cancer, Table of Contents

CC BY-NC-ND 4.0 · South Asian J Cancer 2018; 07(02): 087-090
DOI: 10.4103/sajc.sajc_108_18

Original Article

Practical consensus recommendations regarding role of postmastectomy radiation therapy

D. Singh

Department of Radiation Oncology, Max Hospital, Noida, Uttar Pradesh

,

G. Saini

Department of Radiation Oncology, Max Hospital, Noida, Uttar Pradesh

,

R. Koul

Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi

,

V. Gupta

Department of Surgical Oncology, BLK Super Specialty Hospital, New Delhi

,

D. Abrol

Department or Radiation Oncology, Jammu Medical College, Jammu, Jammu and Kashmir

,

S. De

Department of Radiation Oncology, Jaypee Hospital, Noida, Uttar Pradesh

,

P. Kulshrestha

Department of Radiation Oncology, Metro Hospital and Cancer Institute, New Delhi

,

S. N. Hukku

Department of Radiation Oncology, BLK Super Specialty Hospital, New Delhi

,

S. J. Lakshmi

Department of Radiation Oncology, Artemis Hospital, Gurugram, Haryana

,

Purvish M. Parikh

Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra

,

S. Aggarwal

Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi

› Author Affiliations

Abstract

PDF Download

Abstract

The use of radiation therapy after mastectomy (PMRT) has been limited to those patients who are at significant risk of cancer recurring in the chest wall or in the nodal basins. The use of PMRT has been widely accepted for patients with four or more positive lymph nodes, ^[1],[2] but there is still controversy regarding the value of PMRT for those with one to three positive nodes. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.

Key words

Boost - early breast cancer - hypofractionation - node positive

PDF (433 kb)

References

References
1 Tseng YD, Uno H, Hughes ME, Niland JC, Wong YN, Theriault R, et al. Biological subtype predicts risk of locoregional recurrence after mastectomy and impact of postmastectomy radiation in a large national database. Int J Radiat Oncol Biol Phys 2015;93:622-30.
2 Frasier LL, Holden S, Holden T, Schumacher JR, Leverson G, Anderson B, et al. Temporal trends in postmastectomy radiation therapy and breast reconstruction associated with changes in National Comprehensive Cancer Network Guidelines. JAMA Oncol 2016;2:95-101.
3 Truong PT, Olivotto IA, Whelan TJ, Levine M; Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy. CMAJ 2004;170:1263-73.
4 Eifel P, Axelson JA, Costa J, Crowley J, Curran WJ Jr., Deshler A, et al. National Institutes of Health Consensus Development Conference statement: Adjuvant therapy for breast cancer, November 1-3, 2000. J Natl Cancer Inst 2001;93:979-89.
5 Recht A, Edge SB, Solin LJ, Robinson DS, Estabrook A, Fine RE, et al. Postmastectomy radiotherapy: Clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001;19:1539-69.
6 Veronesi U, Luini A, Del Vecchio M, Greco M, Galimberti V, Merson M, et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med 1993;328:1587-91.
7 Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, Taylor C, Arriagada R, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011;378:1707-16.
8 Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995;333:1456-61.
9 Vinh-Hung V, Verschraegen C. Breast-conserving surgery with or without radiotherapy: Pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. J Natl Cancer Inst 2004;96:115-21.
10 Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, et al. The UK standardisation of breast radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 2013;14:1086-94.
11 Yarnold J, Ashton A, Bliss J, Homewood J, Harper C, Hanson J, et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: Long-term results of a randomised trial. Radiother Oncol 2005;75:9-17.
12 Owen JR, Ashton A, Bliss JM, Homewood J, Harper C, Hanson J, et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: Long-term results of a randomised trial. Lancet Oncol 2006;7:467-71.
13 Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010;362:513-20.
14 Aleman BM, van Leeuwen FE. Hypofractionated adjuvant radiotherapy for breast cancer: No signs of increased risk of cardiotoxicity. Ned Tijdschr Geneeskd 2015;159:A8856.
15 Chan EK, Woods R, Virani S, Speers C, Wai ES, Nichol A, et al. Long-term mortality from cardiac causes after adjuvant hypofractionated vs. conventional radiotherapy for localized left-sided breast cancer. Radiother Oncol 2015;114:73-8.
16 Whelan T, MacKenzie R, Julian J, Levine M, Shelley W, Grimard L, et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst 2002;94:1143-50.
17 van der Laan HP, Hurkmans CW, Kuten A, Westenberg HA; EORTC-ROG Breast Working Party. Current technological clinical practice in breast radiotherapy; results of a survey in EORTC-radiation oncology group affiliated institutions. Radiother Oncol 2010;94:280-5.
18 Kim KS, Shin KH, Choi N, Lee SW. Hypofractionated whole breast irradiation: New standard in early breast cancer after breast-conserving surgery. Radiat Oncol J 2016;34:81-7.
19 Nandi M, Mahata A, Mallick I, Achari R, Chatterjee S. Hypofractionated radiotherapy for breast cancers – preliminary results from a tertiary care center in Eastern India. Asian Pac J Cancer Prev 2014;15:2505-10.
20 Stephan P. What Is a Radiation Boost for Breast Cancer? Radiation Boost Side Effects and Recurrence Benefits. Available from: http://www. Verywell. [Last updated on 2016 Mar 06].
21 Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol 2007;25:3259-65.
22 Romestaing P, Lehingue Y, Carrie C, Coquard R, Montbarbon X, Ardiet JM, et al. Role of a 10-gy boost in the conservative treatment of early breast cancer: Results of a randomized clinical trial in Lyon, France. J Clin Oncol 1997;15:963-8.
23 Omlin A, Amichetti M, Azria D, Cole BF, Fourneret P, Poortmans P, et al. Boost radiotherapy in young women with ductal carcinoma in situ: A multicentre, retrospective study of the Rare Cancer Network. Lancet Oncol 2006;7:652-6.
24 Wong P, Lambert C, Agnihotram RV, David M, Duclos M, Freeman CR, et al. Ductal carcinoma in situ – the influence of the radiotherapy boost on local control. Int J Radiat Oncol Biol Phys 2012;82:e153-8.
25 Zhang J, Wang C. Axillary radiotherapy: An alternative treatment option for adjuvant axillary management of breast cancer. Sci Rep 2016;6:26304.
26 Recht A, Pierce SM, Abner A, Vicini F, Osteen RT, Love SM, et al. Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 1991;9:988-96.
27 Vicini FA, Horwitz EM, Lacerna MD, Brown DM, White J, Dmuchowski CF, et al. The role of regional nodal irradiation in the management of patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 1997;39:1069-76.
28 Courdi A, Chamorey E, Ferrero JM, Hannoun-Lévi JM. Influence of internal mammary node irradiation on long-term outcome and contralateral breast cancer incidence in node-negative breast cancer patients. Radiother Oncol 2013;108:259-65.
29 Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 2015;373:317-27.
30 Thorsen LB, Offersen BV, Danø H, Berg M, Jensen I, Pedersen AN, et al. DBCG-IMN: A population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol 2016;34:314-20.
31 Obedian E, Haffty BG. Internal mammary nodal irradiation in conservatively-managed breast cancer patients: Is there a benefit? Int J Radiat Oncol Biol Phys 1999;44:997-1003.
32 Fowble B, Hanlon A, Freedman G, Nicolaou N, Hoffman J, Sigurdson E, et al. Internal mammary node irradiation neither decreases distant metastases nor improves survival in stage I and II breast cancer. Int J Radiat Oncol Biol Phys 2000;47:883-94.