Role of postmastectomy radiotherapy: A medical oncology perspective

Current practice in the management of patients who undergo a mastectomy does not usually include radiotherapy. Data from both meta-analyses and two randomized studies challenge this approach. Part of the skepticism about postmastectomy radiotherapy is what biological rationale would justify this intervention. Hellman has proposed the spectrum hypothesis, which explains the potential indication for additional local therapy for such patients. Another concern is the risk for increased toxicity, especially cardiotoxicity in patients who receive anthracycline-based adjuvant regimens. The addition of new agents (eg, Herceptin) also requires careful monitoring with regard to toxicity. Furthermore, the timing of radiation with chemotherapy is problematic. Overall, there is now evidence to support a role for postmastectomy radiotherapy, but further studies are needed on how best to incorporate this modality in multimodality treatment of early-stage breast cancer.