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Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update.

Publication ,  Journal Article
Recht, A; Comen, EA; Fine, RE; Fleming, GF; Hardenbergh, PH; Ho, AY; Hudis, CA; Hwang, ES; Kirshner, JJ; Morrow, M; Salerno, KE; Sledge, GW ...
Published in: J Clin Oncol
December 20, 2016

Purpose A joint American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology panel convened to develop a focused update of the American Society of Clinical Oncology guideline concerning use of postmastectomy radiotherapy (PMRT). Methods A recent systematic literature review by Cancer Care Ontario provided the primary evidentiary basis. The joint panel also reviewed targeted literature searches to identify new, potentially practice-changing data. Recommendations The panel unanimously agreed that available evidence shows that PMRT reduces the risks of locoregional failure (LRF), any recurrence, and breast cancer mortality for patients with T1-2 breast cancer with one to three positive axillary nodes. However, some subsets of these patients are likely to have such a low risk of LRF that the absolute benefit of PMRT is outweighed by its potential toxicities. In addition, the acceptable ratio of benefit to toxicity varies among patients and physicians. Thus, the decision to recommend PMRT requires a great deal of clinical judgment. The panel agreed clinicians making such recommendations for individual patients should consider factors that may decrease the risk of LRF, attenuate the benefit of reduced breast cancer-specific mortality, and/or increase risk of complications resulting from PMRT. When clinicians and patients elect to omit axillary dissection after a positive sentinel node biopsy, the panel recommends that these patients receive PMRT only if there is already sufficient information to justify its use without needing to know additional axillary nodes are involved. Patients with axillary nodal involvement after neoadjuvant systemic therapy should receive PMRT. The panel recommends treatment generally be administered to both the internal mammary nodes and the supraclavicular-axillary apical nodes in addition to the chest wall or reconstructed breast.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

December 20, 2016

Volume

34

Issue

36

Start / End Page

4431 / 4442

Location

United States

Related Subject Headings

  • United States
  • Surgical Oncology
  • Societies, Medical
  • Radiotherapy, Adjuvant
  • Radiotherapy Dosage
  • Radiation Oncology
  • Practice Guidelines as Topic
  • Oncology & Carcinogenesis
  • Medical Oncology
  • Mastectomy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Recht, A., Comen, E. A., Fine, R. E., Fleming, G. F., Hardenbergh, P. H., Ho, A. Y., … Edge, S. B. (2016). Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. J Clin Oncol, 34(36), 4431–4442. https://doi.org/10.1200/JCO.2016.69.1188
Recht, Abram, Elizabeth A. Comen, Richard E. Fine, Gini F. Fleming, Patricia H. Hardenbergh, Alice Y. Ho, Clifford A. Hudis, et al. “Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update.J Clin Oncol 34, no. 36 (December 20, 2016): 4431–42. https://doi.org/10.1200/JCO.2016.69.1188.
Recht A, Comen EA, Fine RE, Fleming GF, Hardenbergh PH, Ho AY, et al. Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. J Clin Oncol. 2016 Dec 20;34(36):4431–42.
Recht, Abram, et al. “Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update.J Clin Oncol, vol. 34, no. 36, Dec. 2016, pp. 4431–42. Pubmed, doi:10.1200/JCO.2016.69.1188.
Recht A, Comen EA, Fine RE, Fleming GF, Hardenbergh PH, Ho AY, Hudis CA, Hwang ES, Kirshner JJ, Morrow M, Salerno KE, Sledge GW, Solin LJ, Spears PA, Whelan TJ, Somerfield MR, Edge SB. Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. J Clin Oncol. 2016 Dec 20;34(36):4431–4442.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

December 20, 2016

Volume

34

Issue

36

Start / End Page

4431 / 4442

Location

United States

Related Subject Headings

  • United States
  • Surgical Oncology
  • Societies, Medical
  • Radiotherapy, Adjuvant
  • Radiotherapy Dosage
  • Radiation Oncology
  • Practice Guidelines as Topic
  • Oncology & Carcinogenesis
  • Medical Oncology
  • Mastectomy