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Recommendation
Radiation therapy after neoadjuvant chemotherapy – Node-positive or locally advanced breast cancer
For patients with locally advanced breast cancer and/or involved lymph nodes at presentation who have received neoadjuvant chemotherapy, consider post-mastectomy radiation therapy with or without nodal radiation therapy.
Offer postmastectomy radiotherapy after neoadjuvant chemotherapy if post-treatment histology shows node-positive (macrometastases) breast cancer or involved resection margins
Offer postmastectomy radiotherapy after neoadjuvant chemotherapy if pre-treatment investigations show node-positive (macrometastases) breast cancer
Consider postmastectomy radiotherapy after neoadjuvant chemotherapy if post-treatment histology shows node negative T3 breast cancer
How this guidance was developed
This recommendation was adapted from the NICE 2018 guidelines (UK). Three source recommendations (for different patient populations, based on investigations of macrometastases) were merged to generate a recommendation applicable to all three patient populations. All three source recommendations were based on a systematic review conducted to September 2017: two of these recommendations used wording (‘Offer’) indicative of a strong recommendation and one used wording (‘Consider’) indicative of a conditional recommendation (using GRADE methods) by the source guideline authors. The evidence review by NICE (2018) indicates that there was not enough evidence to recommend subgroups of women in whom postmastectomy radiotherapy could be safely omitted after neoadjuvant chemotherapy. Therefore, the NICE committee agreed that the recommendations for postmastectomy radiotherapy among people who have not received neoadjuvant chemotherapy applied to this population.
Radiation therapy after neoadjuvant chemotherapy – Node-positive or locally advanced breast cancer
Recommendation
For patients with locally advanced breast cancer and/or involved lymph nodes at presentation who have received neoadjuvant chemotherapy, consider post-mastectomy radiation therapy with or without nodal radiation therapy.
Principles in action
Safe and quality care
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Care coordination
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Communication
This recommendation was adapted from the NICE 2018 guidelines (UK). Three source recommendations (for different patient populations, based on investigations of macrometastases) were merged to generate a recommendation applicable to all three patient populations. All three source recommendations were based on a systematic review conducted to September 2017: two of these recommendations used wording (‘Offer’) indicative of a strong recommendation and one used wording (‘Consider’) indicative of a conditional recommendation (using GRADE methods) by the source guideline authors. The evidence review by NICE (2018) indicates that there was not enough evidence to recommend subgroups of women in whom postmastectomy radiotherapy could be safely omitted after neoadjuvant chemotherapy. Therefore, the NICE committee agreed that the recommendations for postmastectomy radiotherapy among people who have not received neoadjuvant chemotherapy applied to this population.