Postmastectomy radiotherapy: Clinical practice guidelines of the American Society of Clinical Oncology

Objective: To determine indications for the use of postmastectomy radiother apy (PMRT) for patients with invasive breast cancer with involved axillary lymph nodes or locally advanced disease who receive systemic therapy. These guidelines are Intended for use in the care of patients outside of clinica l trials. Potential Intervention: The benefits and risks of PMRT in such patients, as well as subgroups of these patients, were considered. The details of the P MRT technique were also evaluated. Outcomes: The outcomes considered included freedom from local-regional recu rrence, survival (disease-free and overall), and long-term toxicity. Evidence: An expert multidisciplinary panel reviewed pertinent information from the published literature through July 2000; certain investigators were contacted for more recent and, in some cases, unpublished information. A c omputerized search was performed of MEDLINE data; directed searches based o n the bibliographies of primary articles were also performed. Values: Levels of evidence and guideline grades were assigned by the Panel using standard criteria. A "recommendation" was made when level I or II evi dence was available and there was consensus as to its meaning. A "suggestio n" was made based on level III, IV, or V evidence and there was consensus a s to its meaning. Areas of clinical importance were pointed out where guide lines could not be formulated due to insufficient evidence or lack of conse nsus. Recommendations: The recommendations, suggestions, and expert opinions of t he Panel are described in this article. Validation: Seven outside reviewers, the American Society of Clinical Oncol ogy (ASCO) Health Services Research Committee members, and the ASCO Board o f Directors reviewed this document. J Clin Oncol 19:1539-1569. (C) 2001 by American Society of Clinical Oncology.