Chest wall radiation therapy after mastectomy refers to the use of external beam radiation to the ipsilateral chest wall including the mastectomy scar and, when indicated, drain sites, as part of postmastectomy radiation therapy (PMRT) for breast cancer.
The primary goal is to reduce the risk of locoregional recurrence and improve survival, especially in patients with node-positive disease or other high-risk features.
Most local regional occurrences occur in the chess wall, so this area is considered to be a critical target for postmastectomy radiotherapy. Rtyrt
PMRT typically includes not only the chest wall but also regional lymphatics (such as the supraclavicular, axillary, and sometimes internal mammary nodes) when indicated.
Guidelines recommend chest wall irradiation for most patients with positive axillary nodes, select node-negative patients with high-risk features, and those with locally advanced disease after neoadjuvant therapy.
Mastectomy it standandard of care for more than 1/3 of patients with stage I and stage II breast cancer.
Stage II disease involves tumors, no more than 5 cm in diameter with metastases to 1-3 axillary lymph nodes (N1) or tumors of at least 2 cm without nodal metastases stages T1N1M0, T2N1M0, and T3N0M0, in the TNM classification.
PatienTS with stage II breast cancer with N1 disease or have N0 disease, but with poor histologic features are considered to be intermediate risk for recurrence.
Previous studies with what is now considered sub optimal adjuvant therapy reported that post mastectomy radiotherapy for a stages II and III reduced the risk of local regional recurrence and improved 10 year survival among women with nodal metastases.
Chest wall radiation therapy after mastectomy is a core component of PMRT, targeting the chest wall and often regional nodes to reduce recurrence and improve outcomes in appropriately selected breast cancer patients.
In the SUPREMO trial 10 year survival after post mastectomy chestwall radiation in breast cancer patients classified as PN1 with involvement of 1 to 3 three nodes or PnO pathologically node negative with additional risk factors treated with mastectomy and contemporary adjuvant systemic therapy did not result in higher overall survival than no chest radiation among these intermediate risk patients with early breast cancer.
Major improvement, systemic therapy and reduction in breast cancer mortality challenge the applicability of the evidence base for postmastectomy radiotherapy in current practice.