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Postmastectomy irradiation: rationale for treatment field selection.
1Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Seminars in Radiation Oncology
|June 23, 1999
Summary
Postmastectomy radiation therapy targets residual cancer after mastectomy. High-risk patients benefit most from chest wall and paraclavicular irradiation to reduce locoregional recurrence.
Area of Science:
- Oncology
- Radiation Oncology
- Surgical Oncology
Background:
- Postmastectomy irradiation aims to eradicate subclinical disease post-mastectomy.
- Patient selection and treatment volumes rely on diverse data due to subclinical disease.
- Locoregional recurrence risk is influenced by disease stage, lymphatic involvement, and prior treatments.
Purpose of the Study:
- To determine optimal target volumes for postmastectomy irradiation.
- To identify patient subsets most likely to benefit from radiation therapy.
- To analyze patterns of failure in locoregional recurrence.
Main Methods:
- Review of data sources to infer patient selection and treatment volumes.
- Analysis of patterns of failure in locoregional recurrence.
- Examination of prospective trials evaluating postmastectomy irradiation survival benefits.
Main Results:
- The chest wall is the primary target for radiation in high-risk patients, involved in 60-80% of recurrences.
- Paraclavicular lymphatics are the second most common site of failure (10-35%).
- Internal mammary chain irradiation is included in trials showing survival benefit, though local failure is uncommon; axillary irradiation benefits a subset of patients.
Conclusions:
- Postmastectomy irradiation is crucial for high-risk patients, focusing on the chest wall and paraclavicular region.
- Internal mammary and axillary lymphatics require careful consideration for irradiation based on individual risk factors.
- Optimizing radiation therapy volumes improves outcomes by targeting sites of potential locoregional recurrence.