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Regional Nodal Irradiation and Post-Mastectomy Radiation Therapy After Up-Front Surgery

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Abstract

Purpose of Review

This review serves to summarize available data impacting treatment decisions for the use of post-mastectomy radiation (PMRT) and regional nodal irradiation (RNI).

Recent Findings

In the last decade, there have been ongoing shifts in breast cancer management, including changes in the type and sequencing of systemic therapy tailored to receptor subtype and molecular profiling, changes to the surgical management of the regional nodes, and improvements in radiation treatment planning and delivery technology. In this chapter, we will consider historic and modern indications for PMRT and RNI after up-front surgery and discuss how the changing paradigms of surgical and systemic management continue to impact the role of PMRT and RNI.

Summary

The majority of patients with lymph node-positive breast cancer will have some benefit from PMRT and/or RNI, but in the modern era, the impact may be modest, particularly for patients with low-volume nodal involvement. Clinical trial enrollment, tailored recommendations, and shared decision making are important to optimize treatment decisions.

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Data Availability

All material and data were prepared by the authors, and do not contain any third party material.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN, 55455, USA

    Teresa P. Easwaran & Sara R. Alcorn

  2. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Weinberg Building, Suite 1440, Baltimore, MD, 21287, USA

    Jean L. Wright

Authors
  1. Teresa P. Easwaran
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  2. Sara R. Alcorn
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  3. Jean L. Wright
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Contributions

T.P.E prepared figures. T.P.E., S.R.A, and J.L.W. wrote the main manuscript text. All authors also reviewed the manuscript.

Corresponding author

Correspondence to Jean L. Wright.

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Ethical Approval

This article does not contain any studies with human or animal subjects performed by any of the authors.

Competing Interests

Sara Alcorn, MD, MPH, PhD, has a leadership role as Breast Associate Editor for the International Journal of Radiation Oncology Biology and Physics. Jean L Wright MD is Chair of the ASTRO Clinical Affairs and Quality Committee, as well as serves as the Breast Section Editor for the International Journal of Radiation Oncology Biology and Physics. Teresa P Easwaran, MD, MS, declares no competing interests.

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Easwaran, T.P., Alcorn, S.R. & Wright, J.L. Regional Nodal Irradiation and Post-Mastectomy Radiation Therapy After Up-Front Surgery. Curr Breast Cancer Rep 15, 196–203 (2023). https://doi.org/10.1007/s12609-023-00504-3

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