Tailoring Postmastectomy Radiotherapy

Modified radical mastectomy with axillary lymph node dissection/sentinel lymph node biopsy is the standard of care for oncologic surgery in breast cancer patients. In the adjuvant setting, radiotherapy after mastectomy provides clinically relevant improvements in locoregional control and overall survival. The classical indications of adjuvant radiotherapy postmastectomy include large primary and node-positive disease seen on pathology. With the advent of certain newer interventions in oncological practice, viz. neoadjuvant chemotherapy and breast implant after mastectomy, the indication, timing, or dose fractionation of radiation has become doubtful in such settings. The present chapter summarizes the indications and acceptable dose fractionation of postmastectomy radiotherapy and discusses controversies in postmastectomy radiotherapy.