Defining the role of post-mastectomy radiotherapy: the new evidence.

In an early meta-analysis of the post-mastectomy radiotherapy trials, the use of obsolete radiotherapy techniques resulted in increased cardiac mortality. With maturation of these data and inclusion of more recent trials, however, a survival advantage is now emerging. This, in concert with the improvement in disease-free and overall survival evident in the larger studies of post-mastectomy radiotherapy with adjuvant chemotherapy, generates a new enthusiasm in support of post-mastectomy radiotherapy. The lessons we have learned from the earlier trials emphasize the importance of precise radiation planning and delivery so that long-term morbidity can be minimized and survival improved by the reduction in breast cancer deaths.