Post-Mastectomy Radiation Therapy: Applications and Advancements

Purpose of Review Post-mastectomy radiotherapy (PMRT) has been shown to improve locoregional control and survival rates when administered to high-risk breast cancer patients. This review provides a compendium of instrumental studies, extant indications, current evidence, and ongoing trials as they pertain to PMRT utilization. Recent Findings Increasing evidence supports hypofractionated irradiation as an equivalent, if not superior, alternative to standard fractionation. There is growing interest in PMRT delivery techniques that limit cardiopulmonary radiation exposure. The safety and efficacy profile of proton beam radiotherapy appear similar to conventional irradiation with the potential advantage of reduced cardiac toxicity. Numerous active studies are investigating the impact of PMRT in patients considered to be at intermediate risk of disease recurrence. Summary The approach to PMRT should be personalized based on individual risk factors and tumor biology. As radiotherapy techniques and genomic testing continue to improve, there may be a role for PMRT de-escalation in particular subpopulations with breast cancer.