New Clinical Guidelines for Postmastectomy Radiation Therapy in Breast Cancer Patients

Recently published in the journal Practical Radiation Oncology on September 16, 2025, a comprehensive set of clinical practice guidelines has been established for the application of postmastectomy radiation therapy (PMRT). Developed by a multidisciplinary task force led by Dr. Rachel B. Jimenez from Massachusetts General Hospital, these recommendations aim to optimize treatment strategies for breast cancer patients undergoing mastectomy.

The guidelines emphasize that PMRT is highly indicated for patients with node-positive breast cancer, and may also benefit some patients with node-negative disease following upfront mastectomy. For those with locally advanced disease or residual nodal disease after neoadjuvant systemic therapy, PMRT is recommended to reduce the risk of recurrence. Additionally, for patients with clinical tumor stages T1-3N1 or T3N0 who have negative nodes after systemic therapy, PMRT is conditionally advised.

Treatment planning advocates for the use of advanced imaging, specifically computed tomography-based volumetric planning with three-dimensional conformal radiotherapy. When goal achievement is not possible with 3D conformal RT, intensity-modulated radiotherapy (IMRT) is recommended to enhance precision. To minimize damage to normal tissues, deep inspiration breath-hold techniques are advised, especially in cases where vital structures are at risk.

In cases involving skin or superficial margins, the use of a tissue-equivalent bolus is recommended to ensure adequate dose delivery; however, routine use of bolus material is not advised across all cases.

The guidelines also underline that the benefits of PMRT must be balanced with individual patient characteristics and personal preferences, underscoring the importance of personalized, evidence-based decision-making. Overall, these guidelines aim to improve clinical outcomes and tailor therapy to each patient’s unique disease profile.

For further details, the guidelines and clinical recommendations can be accessed in the September 2025 issue of Practical Radiation Oncology. These updates support clinicians in making informed choices while advancing breast cancer treatment protocols.

source: https://medicalxpress.com/news/2025-09-guidelines-postmastectomy-therapy.html