Does adjuvant radiotherapy have a role in the postmastectomy management of patients with operable breast cancer--revisited.

About 2 decades ago, "routine" adjunctive postmastectomy radiotherapy, especially for axillary node-positive patients, was the norm and uncriticized standard against which adequate treatment was measured in most centers. With the advent of cyclic, aggressive, multi-agent chemotherapy and anti-hormones used as adjuvants, especially within the last decade, there has been tremendous reduction in patients referred to the radiation oncologist for consideration of adjunctive postmastectomy radiotherapy. This presentation will attempt to define a role for radiotherapy in at least selected subsets of patients who undergo modified radical mastectomy, based upon published series in the literature. Breast cancer is a protean disease and deserves a multidisciplinary approach to evaluation and treatment. "Routine" adjunctive postmastectomy radiotherapy for all patients with operable breast cancer obviously is not indicated, but there appear to be groups of patients who benefit from radiotherapy, both from the standpoint of disease-free survival and improved quality of life, and . . . in very narrow subsets, absolute survival. In some of these subsets the benefit clinically may be greater than that resulting from chemotherapy or anti-hormone therapy, although, because of sample size, falling short of statistical verification. In response to the posed question, while this remains a controversial issue, there appears to be a role for selective adjunctive postmastectomy radiotherapy in specific subsets of patients, and physicians administering adjunctive breast cancer therapy with sweeping applications of chemotherapy or anti-hormones alone do not appear to be offering their patients optimal therapy.