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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 8/2014

01-08-2014 | Original article

DEGRO practical guidelines for radiotherapy of breast cancer IV

Radiotherapy following mastectomy for invasive breast cancer

Authors: Frederik Wenz, Elena Sperk, Wilfried Budach, Jürgen Dunst, Petra Feyer, Rainer Fietkau, Wulf Haase, Wolfgang Harms, Marc D. Piroth, Marie-Luise Sautter-Bihl, Felix Sedlmayer, Rainer Souchon, Christoph Fussl, Rolf Sauer, Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)

Published in: Strahlentherapie und Onkologie | Issue 8/2014

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Abstract

Background and purpose

Since the last recommendations from the Breast Cancer Expert Panel of the German Society for Radiation Oncology (DEGRO) in 2008, evidence for the effectiveness of postmastectomy radiotherapy (PMRT) has grown. This growth is based on updates of the national S3 and international guidelines, as well as on new data and meta-analyses. New aspects were considered when updating the DEGRO recommendations.

Methods

The authors performed a comprehensive survey of the literature. Data from recently published (meta-)analyses, randomized clinical trials and international cancer societies’ guidelines yielding new aspects compared to 2008 were reviewed and discussed. New aspects were included in the current guidelines. Specific issues relating to particular PMRT constellations, such as the presence of risk factors (lymphovascular invasion, blood vessel invasion, positive lymph node ratio > 20 %, resection margins < 3 mm, G3 grading, young age/premenopausal status, extracapsular invasion, negative hormone receptor status, invasive lobular cancer, size > 2 cm or a combination of ≥ 2 risk factors) and 1–3 positive lymph nodes are emphasized.

Results

The evidence for improved overall survival and local control following PMRT for T4 tumors, positive resection margins, > 3 positive lymph nodes and in T3 N0 patients with risk factors such as lymphovascular invasion, G3 grading, close margins, and young age has increased. Recently identified risk factors such as invasive lobular subtype and negative hormone receptor status were included. For patients with 1–3 positive lymph nodes, the recommendation for PMRT has reached the 1a level of evidence.

Conclusion

PMRT is mandatory in patients with T4 tumors and/or positive lymph nodes and/or positive resection margins. PMRT should be strongly considered in patients with T3 N0 tumors and risk factors, particularly when two or more risk factors are present.
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Metadata
Title
DEGRO practical guidelines for radiotherapy of breast cancer IV
Radiotherapy following mastectomy for invasive breast cancer
Authors
Frederik Wenz
Elena Sperk
Wilfried Budach
Jürgen Dunst
Petra Feyer
Rainer Fietkau
Wulf Haase
Wolfgang Harms
Marc D. Piroth
Marie-Luise Sautter-Bihl
Felix Sedlmayer
Rainer Souchon
Christoph Fussl
Rolf Sauer
Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 8/2014
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-014-0687-0

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