Journal of Hong Kong College of Radiologists

Volume 4 Number 1, 2001
Abstract

Postmastectomy radiotherapy: A review

I Kunkler,
University Department of Clinical Oncology, Western General Hospital, University of Edinburgh, United Kingdom

The role of postmastectomy radiotherapy (PMRT) has been controversial for more than half a century. Interpretation of the true benefit of PMRT for local control and survival remains difficult to assess because of the heterogeneity of surgery and differing indications for PMRT over time. In addition, the introduction of adjuvant systemic therapy in the 1970s added a further parameter that could influence local control and survival. Overall, PMRT achieves a two-thirds reduction in local recurrence. There is an increasing awareness of the potential for radiation induced cardiac morbidity and mortality from PMRT. There is recent evidence that PMRT confers a survival advantage in premenopausal and postmenopausal women at high risk of local recurrence. However this survival benefit may be reduced or negated by late radiation induced cardiac mortality. Technological advances in the delivery of radiotherapy should enable unwanted dosage to the heart to be minimised. The role of PMRT in patients at intermediate risk of relapse after mastectomy and systemic therapy is unclear in pre- and postmenopausal patients. New trials stratified by prognostic factors are needed to evaluate this. (J HK Coll Radiol 2001;1:21-26)

Key words : Postmastectomy radiotherpay, Local control, Survival benefit, Cardiac mortality


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