What are the radiation therapy (RT) recommendations for patients undergoing total mastectomy for the treatment of breast cancer?

Updated: Apr 23, 2020
  • Author: Joseph A Sparano, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Answer

Patients undergoing total mastectomy with surgical axillary staging, with or without reconstruction

RT recommendations are based on the patient's axillary node status, as follows:

  • Four or more positive axillary nodes – Postchemotherapy RT to the chest wall plus the infraclavicular and supraclavicular areas; consider RT to internal mammary nodes

  • One to three positive axillary nodes – Consider postchemotherapy RT to the chest wall, with or without infraclavicular and supraclavicular nodes; consider RT to internal mammary nodes

  • Negative axillary nodes and tumor >5 cm or positive margins – Consider RT to the chest wall, with or without infraclavicular and supraclavicular nodes; consider RT to internal mammary nodes

  • Negative axillary nodes, tumor ≤5 cm, and margins < 1 mm – Postchemotherapy RT to the chest wall is recommended

  • Negative axillary nodes, tumor ≤5 cm, and margins ≥1 mm – No RT is needed


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