The role of radiotherapy following total mastectomy for patients with early breast cancer

Analysis from a multicenter trial of the management of operable breast cancer now in its fifteenth year has confirmed earlier published results that there are no significant differences in survival and distant recurrence between the two treatment groups (“watch policy” and radiotherapy). However, patients receiving prophylactic radiotherapy at the time of mastectomy continue to have a reduced risk of developing local recurrence as the first sign of treatment failure (p<0.001). This increased risk is related to various known prognostic indicators such as tumor size and histological grade. Detailed analysis of local recurrence data has shown protection for the radiotherapy patients against recurrence in the chest wall and axilla but not in the supraclavicular area. The question of uncontrolled local disease persisting to death has also been addressed.