[Why radiation for the postmastectomy patient?].

Area of Science:

• Oncology
• Radiotherapy
• Surgical Oncology

Background:

• Identifying patients at high risk for loco-regional relapse after mastectomy is crucial.
• Historically, radiotherapy concerns included long-term cardiac mortality, despite improved breast-specific survival.
• The overall survival benefit of postmastectomy radiotherapy was previously uncertain.

Purpose of the Study:

• To evaluate the efficacy and safety of postmastectomy radiotherapy in reducing loco-regional relapse.
• To assess the impact of radiotherapy on overall survival in conjunction with adjuvant systemic treatment.
• To analyze the influence of tumor characteristics on radiotherapy's survival benefit.

Main Methods:

• Analysis of a subgroup of patients with high risk of loco-regional relapse.
• Review of recent randomized trials on postmastectomy radiotherapy outcomes.
• Comparison of survival data between irradiated and non-irradiated patient groups.

Main Results:

• Radiotherapy reduced absolute loco-regional relapse risk by over 10% (66% relative risk reduction, p < 0.0001).
• Severe complication rates associated with radiotherapy were less than 1%.
• Three recent trials demonstrated a 10% improvement in overall survival when radiotherapy was added to adjuvant systemic treatment, particularly for less advanced tumors.

Conclusions:

• Postmastectomy radiotherapy is effective in reducing loco-regional relapse for high-risk patients with minimal severe complications.
• Modern radiotherapy significantly improves overall survival when integrated with adjuvant systemic therapy.
• The survival benefit of radiotherapy is more substantial in patients with less advanced tumor stages.