Guidelines Change For Postmastectomy Radiation

Some women who are diagnosed with particular types of breast cancer may soon find their healthcare providers advocating more strongly for the use of postmastectomy radiation while others may discover the opposite to be true. On the heels of a large study, the American Society of Clinical Oncology has updated its guidelines in regard to radiation use for some forms of breast cancer for the first time since 2001. The guidelines in question pertain to the use of radiation after surgery for women diagnosed with T1-T2 breast cancer who also have one to three positive auxiliary lymph nodes.

The study that prompted a new look at the old guidelines actually involved a meta-analysis of some 22 clinical trials published since 2001. All told, the trials represented more than 8,000 women who were randomly selected to receive or not receive postmastectomy radiation. Researchers found that the 10-year rate of locoregional treatment failure was less than 5 percent for women who underwent post-surgical radiation. The rate was 21 percent for those who did not receive radiation as a follow up treatment. The 10-year rates for local or distant treatment failure were about 34 percent with irradiation and 45 percent without it.

The panel that reviewed the trials ultimately came to the conclusion that postmastectomy radiation can reduce recurrence rate, locoregional failure and mortality for patients who met the T1-T2 criterial. They, however, also are now urging doctors and patients to carefully consider other factors before setting a course toward radiation. Given its potential side effects, factors such as older patient age, limited life expectancy, co-morbidities, small tumor size and low tumor grade may make holding off the best course of action.

It is estimated that some 231,000 American women will be diagnosed with invasive breast cancer in the coming year. About 40,000 women will die from the disease. Women who are diagnosed with breast cancer are urged to carefully discuss all treatment options with their healthcare providers.

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