Dr. Freedman on the NCCN Guidelines for Post-Mastectomy Radiation

Laura M. Freedman, MD, assistant professor, director of Radiation Oncology, Sylvester Comprehensive Cancer Center, discusses the revised National Comprehensive Cancer Network (NCCN) guidelines for post-mastectomy radiation given in women who have pathologic T1 and T2 tumors and 1 to 3 positive lymph nodes.

It is known that patients with no lymph nodes involved do not derive a benefit from post-mastectomy radiation, although there are exceptions. For example, high-risk patients and those with positive margins and early-stage tumors, typically do not show additional benefit post-mastectomy.

For patients with 4 or more positive nodes, the addition of radiation provides a positive benefit in terms of local recurrence and overall survival. The data on patients with 1 to 3 positive lymph nodes has been more difficult to obtain. The NCCN guidelines will help streamline the use of radiation in what tends to be a more heterogeneous group of patients, explains Freedman.