Radiation organizations issue guidance on postmastectomy radiation therapy

The American Society for Radiation Oncology (ASTRO), the American Society of Clinical Oncology (ASCO), and the Society of Surgical Oncology (SSO) have issued updated clinical guidelines on postmastectomy radiation therapy (PMRT) for physicians treating patients with breast cancer.

The new document has been published in the journals of the three societies.

The guidance, which was first published in 2001 and most recently updated in 2016, was written by a multidisciplinary panel of academic and community-based radiation, medical, and surgical oncologists, a medical physicist, and a patient representative. The updated recommendations were based on a systematic review of research published between 2005 and 2024.

The guidelines outline when the use of PMRT is appropriate based on advances in diagnostics and clinical practice, and reviews best practices for delivering radiation after breast removal surgery, the organizations said.

The document provides information on appropriate target volumes, dosing, and treatment techniques. In addition, authors review treatment approaches aimed at reducing side effects and improving outcomes, including advances in radiation techniques, less invasive axillary surgery, and tailored systemic therapies.

Some of the important updates include specific recommendations for making treatment decisions for patients with node-positive and node-negative disease, as well as for patients receiving neoadjuvant systemic therapy. Furthermore, the guidance underscores the importance of shared, informed decision-making with all healthcare professionals treating the patient, as well as the patient, in determining the best treatment approach to use.

The guidance is available in ASTRO’s Practical Radiation Oncology, ASCO’s Journal of Clinical Oncology, and the SSO’s Annals of Surgical Oncology.