Postmastectomy Radiation Therapy: An ASTRO-ASCO-SSO Clinical Practice Guideline
After upfront mastectomy, PMRT is indicated for most patients with node-positive breast cancer and select patients with node-negative disease. PMRT is also recommended after neoadjuvant systemic therapy for patients presenting with locally advanced disease and for those with residual nodal disease at the time of surgery. PMRT is conditionally recommended for patients with cT1-3N1 or cT3N0 breast cancer with pathologically negative nodes after neoadjuvant systemic therapy (ypN0). When PMRT is delivered, treatment to the ipsilateral chest wall or reconstructed breast and regional lymphatics is recommended, with moderate hypofractionation preferred, but with conventional fractionation approaches acceptable in rare cases. Computed tomography-based volumetric treatment planning with 3-dimensional conformal RT is recommended, with intensity-modulated RT advised when three-dimensional conformal RT is unable to achieve treatment goals. Deep inspiration breath-hold techniques are also recommended for normal tissue sparing. For patients with skin involvement, positive superficial margins, and/or lymphovascular invasion, use of a bolus is recommended, but routine use of tissue-equivalent bolus is not recommended.Additional information is available at www.asco.org/breast-cancer-guidelines.
Authors
- Yara George Abdou (ORCID: https://orcid.org/0000-0002-4827-8613)
- Kekoa Taparra (ORCID: https://orcid.org/0000-0001-8493-3868)
- Jean L. Wright (ORCID: https://orcid.org/0000-0001-5775-6544)
- Chantal R. Reyna (ORCID: https://orcid.org/0000-0001-7117-3716)
- Richard C. Zellars (ORCID: https://orcid.org/0000-0003-3333-6224)
- Rachel Rabinovitch (ORCID: https://orcid.org/0000-0002-6016-2226)
- Youssef H. Zeidan (ORCID: https://orcid.org/0000-0002-1951-8585)
- Atif J. Khan (ORCID: https://orcid.org/0000-0001-8640-8530)
- Lisa Bradfield (ORCID: https://orcid.org/0000-0003-2703-0501)
- Deborah E. Schofield
- Kathleen C. Horst (ORCID: https://orcid.org/0000-0003-3883-8848)
- Julie A. Bradley (ORCID: https://orcid.org/0000-0001-7581-4605)
- Rachel Jimenez (ORCID: https://orcid.org/0000-0001-7368-1204)
- Cindy Matsen (ORCID: https://orcid.org/0000-0003-0179-5311)
- Kilian Salerno (ORCID: https://orcid.org/0000-0002-5782-660X)
- Iman Washington (ORCID: https://orcid.org/0000-0003-2118-9634)
- Sarah Schellhorn (ORCID: https://orcid.org/0000-0002-8837-1425)
- Parul Barry (ORCID: https://orcid.org/0000-0002-9759-4671)
- Penny R. Anderson
- L. Heras
Institutions
- University of North Carolina at Chapel Hill (US)
- Fox Chase Cancer Center (US)
- Loyola University Medical Center (US)
- Memorial Sloan Kettering Cancer Center (US)
- The University of Texas MD Anderson Cancer Center (US)
- Lynn University (US)
- University of California, Los Angeles (US)
- Breast Cancer Research Foundation (US)
- Huntsman Cancer Institute (US)
- American Society for Radiation Oncology (US)
- Moffitt Cancer Center (US)
- Yale University (US)
- University of Florida (US)
- Massachusetts General Hospital (US)
- UPMC Hillman Cancer Center (US)
- National Cancer Institute (US)
- Indiana University School of Medicine
- Indiana University – Purdue University Indianapolis (US)
- University of Colorado Denver (US)
- Stanford University (US)
Publication Details
- Journal
- Journal of Clinical Oncology
- Published
- 2025-09-16
- DOI
- https://doi.org/10.1200/jco-25-01747
- Citations
- 16
- Primary Topic
- Breast Cancer Treatment Studies
- Type
- article
- Field-Weighted Citation Impact
- 14.98