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Background <p>The role of Postmastectomy Radiation Therapy in women with tumor less than 5&#xa0;cm and 1–3 positive nodes has been a topic of debate. The early doubts about giving Radiation were partially overcome by improved radiation techniques and systemic treatments. When postmastectomy chest-wall irradiation was added to patients with intermediate-risk breast cancer, SUPREMO trial showed no discernible increase in overall survival [8]. Due to the low baseline locoregional recurrence risk in this population, postmastectomy chest-wall irradiation was linked to a slight decrease in chest-wall recurrence, but the absolute benefit was minimal. On the other hand, significant improvements in survival and significant decreases in recurrence were reported in previous trials [1–7]. The SUPREMO trial backs a paradigm change in the use of PMRT for intermediate-risk breast cancer from routine to selective. These results highlight the significance of tailored, interdisciplinary decision-making that incorporates pathological risk factors, tumor biology, patient preferences, and reconstructive considerations for radiation oncologists and surgeons.</p> Methods <p>Using historical data from the Danish Breast Cancer Cooperative Group trials, the Canadian British Columbia trial, and the Early Breast Cancer Trialists’ Collaborative Group meta-analysis [1–7], this narrative review critically evaluates the SUPREMO trial’s design, outcomes, and clinical implications. Multidisciplinary interpretation is emphasized, with implications for breast reconstruction, radiation field selection, surgical decision-making, and tumor board practice.</p> Results <p>When postmastectomy chest-wall irradiation was added to patients with intermediate-risk breast cancer receiving mastectomy and modern systemic therapy, SUPREMO showed no discernible increase in overall survival [8]. Due to the low baseline locoregional recurrence risk in this population, PMRT was linked to a slight decrease in chest-wall recurrence, but the absolute benefit was minimal. On the other hand, significant improvements in survival and significant decreases in recurrence were reported in previous trials [1–7].</p> Conclusion <p>SUPREMO shows that routine postmastectomy chest wall irradiation does not improve survival in intermediate-risk breast cancer treated with modern multimodality therapy, supporting a selective approach to PMRT. Therefore, PMRT decisions should be individualized within a multidisciplinary framework, incorporating tumor biology, systemic therapy, pathological response, and optimum axillary management.</p>

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Revisiting Post-Mastectomy Radiation Therapy in the Modern Era: A Multidisciplinary Review of the SUPREMO Trial

  • 期刊论文

  • 发表日期：

    2026年5月5日

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  • Simran Khatri,
  • Anusheel Munshi,
  • Rohit Kumar C,
  • Ram Alva,
  • S. P. Somashekhar

摘要

Background

The role of Postmastectomy Radiation Therapy in women with tumor less than 5 cm and 1–3 positive nodes has been a topic of debate. The early doubts about giving Radiation were partially overcome by improved radiation techniques and systemic treatments. When postmastectomy chest-wall irradiation was added to patients with intermediate-risk breast cancer, SUPREMO trial showed no discernible increase in overall survival [8]. Due to the low baseline locoregional recurrence risk in this population, postmastectomy chest-wall irradiation was linked to a slight decrease in chest-wall recurrence, but the absolute benefit was minimal. On the other hand, significant improvements in survival and significant decreases in recurrence were reported in previous trials [1–7]. The SUPREMO trial backs a paradigm change in the use of PMRT for intermediate-risk breast cancer from routine to selective. These results highlight the significance of tailored, interdisciplinary decision-making that incorporates pathological risk factors, tumor biology, patient preferences, and reconstructive considerations for radiation oncologists and surgeons.

Methods

Using historical data from the Danish Breast Cancer Cooperative Group trials, the Canadian British Columbia trial, and the Early Breast Cancer Trialists’ Collaborative Group meta-analysis [1–7], this narrative review critically evaluates the SUPREMO trial’s design, outcomes, and clinical implications. Multidisciplinary interpretation is emphasized, with implications for breast reconstruction, radiation field selection, surgical decision-making, and tumor board practice.

Results

When postmastectomy chest-wall irradiation was added to patients with intermediate-risk breast cancer receiving mastectomy and modern systemic therapy, SUPREMO showed no discernible increase in overall survival [8]. Due to the low baseline locoregional recurrence risk in this population, PMRT was linked to a slight decrease in chest-wall recurrence, but the absolute benefit was minimal. On the other hand, significant improvements in survival and significant decreases in recurrence were reported in previous trials [1–7].

Conclusion

SUPREMO shows that routine postmastectomy chest wall irradiation does not improve survival in intermediate-risk breast cancer treated with modern multimodality therapy, supporting a selective approach to PMRT. Therefore, PMRT decisions should be individualized within a multidisciplinary framework, incorporating tumor biology, systemic therapy, pathological response, and optimum axillary management.