Clinical Edge

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Postmastectomy Radiation Therapy and Reconstruction

Assessing the effects of guideline changes

Guideline changes have been associated with an increase in postmastectomy radiation therapy (PMRT) among patients with tumors 5 cm or smaller and 1 to 3 positive nodes without an associated decrease in reconstruction. This according to a study of 62,442 patients with stage I to III breast cancer who were grouped according to National Comprehensive Cancer Network guidelines into 3 cohorts: “radiotherapy recommended,” “strongly consider radiotherapy,” and “radiotherapy not recommended.” Researchers’ findings included:

• Rates of PMRT were unchanged in the radiotherapy recommended (29.9%) and radiotherapy not recommended (7.4%) cohorts over the study period.

• The rate of PMRT for the strongly consider radiotherapy cohort was unchanged at 26.9% until 2007, then increased significantly through the end of the study period, to 40.5%.

• Breast reconstruction increased across all cohorts.

• Despite increasing receipt of PMRT, the strongly consider radiotherapy cohort maintained a consistent increase in reconstruction throughout the study period.

Citation: Frasier LL, Holden S, Holden T, et al. Temporal trends in postmastectomy radiation therapy and breast reconstruction associated with changes in National Comprehensive Cancer Network guidelines. [Published online ahead of print November 5, 2015]. JAMA Oncol. doi:10.1001/jamaoncol.2015.3717.