Factors that Could Lead to Omission of Post Mastectomy Radiation Therapy (PMRT)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Although there are proven benefits for the application of radiation therapy in patients with node positive disease following their mastectomy:
    • There are subsets of individuals where the risks of radiation (toxicities) must be weighed by the potential benefits
  • As part of a multidisciplinary conversation, there are a number of factors that should be considered prior to the utilization of postmastectomy radiation therapy (PMRT):
    • Factors that could lead to omission of PMRT include:
      • Patient factors:
        • Increased patient age:
          • > 40-45
        • Limited life expectancy:
          • Age or comorbidities
        • Coexisting conditions that could increase radiation related complications
      • Pathologic factors: 
        • Lower tumor burden:
          • T1 tumor size
      • Absence of lymphovascular invasion
      • Presence of only a single positive node and / or small size of nodal metastases
      • Substantial response to neoadjuvant chemotherapy
      • Biologic characteristics: 
        • Low tumor grade
        • Strong hormonal sensitivity
  • References
    • Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. Ann Surg Oncol. 2017;24(1):38-51.
    • McBride A, Allen P, Woodward W, et al. Locoregional recurrence risk for patients with T1,2 breast cancer with 1-3 positive lymph nodes treated with mastectomy and systemic treatment. Int J Radiat Oncol Biol Phys. 2014;89(2):392-398.
    • Lai SF, Chen YH, Kuo WH, et al. Locoregional recurrence risk for postmastectomy breast cancer patients with T1-2 and one to three positive lymph nodes receiving modern systemic treatment without radiotherapy. Ann Surg Oncol. 2016;23(12):3860-3869.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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