Post-mastectomy radiation therapy in breast cancer patients with 1-3 positive lymph nodes: No one size fits all

Post-mastectomy radiation therapy (PMRT) is standard therapy for advanced breast cancer. However, given the lower risk of recurrence, PMRT administration remains controversial in select patients with limited nodal disease. We performed a review of the literature that focuses on the effect of PMRT in breast cancer patients with 1-3 positive lymph nodes, mainly examining loco-regional recurrence (LRR) and overall survival (OS). Most studies, including a large meta-analysis by the EBCTCG, showed a significant improvement in LRR rates among patients receiving PMRT. While most studies demonstrated a trend towards OS improvement, only few studies showed a statistically significant OS or breast cancer-specific survival benefit for PMRT. As such, individualized treatment decisions are recommended, taking into consideration clinicopathological findings. Future studies with large sample sizes and long follow-up times are still needed to better assess the role of PMRT in patients with limited nodal involvement.