Postmastectomy Radiotherapy: Clinical Practice Guidelines of the American Society of Clinical Oncology*

<jats:p> OBJECTIVE: To determine indications for the use of postmastectomy radiotherapy (PMRT) for patients with invasive breast cancer with involved axil-lary lymph nodes or locally advanced disease who receive systemic therapy. These guidelines are intended for use in the care of patients outside of clinical trials. </jats:p><jats:p> POTENTIAL INTERVENTION: The benefits and risks of PMRT in such patients, as well as subgroups of these patients, were considered. The details of the PMRT technique were also evaluated. </jats:p><jats:p> OUTCOMES: The outcomes considered included freedom from local-regional recurrence, survival (disease-free and overall), and long-term toxicity. </jats:p><jats:p> EVIDENCE: An expert multidisciplinary panel reviewed pertinent information from the published literature through July 2000; certain investigators were contacted for more recent and, in some cases, unpublished information. A computerized search was performed of MEDLINE data; directed searches based on the bibliographies of primary articles were also performed. </jats:p><jats:p> VALUES: Levels of evidence and guideline grades were assigned by the Panel using standard criteria. A “recommendation” was made when level I or II evidence was available and there was consensus as to its meaning. A “suggestion” was made based on level III, IV, or V evidence and there was consensus as to its meaning. Areas of clinical importance were pointed out where guidelines could not be formulated due to insufficient evidence or lack of consensus. </jats:p><jats:p> RECOMMENDATIONS: The recommendations, suggestions, and expert opinions of the Panel are described in this article. </jats:p><jats:p> VALIDATION: Seven outside reviewers, the American Society of Clinical Oncology (ASCO) Health Services Research Committee members, and the ASCO Board of Directors reviewed this document. </jats:p>