ABSTRACT
The indications for postmastectomy radiotherapy (PMRT) have broadened with up to 30% of patients being offered chest wall irradiation, although this is dependent on medical center with some persistent controversy. PMRT generally aims to deliver broad coverage of the chest wall, treat the ipsilateral supraclavicular fossa and axillary apex, avoid the heart, and minimize the amount of lung tissue within the therapy field. Schechter and colleagues examined 18 different PMRT plans for patients who had undergone reconstruction prior to radiotherapy. A score was developed and two board certified radiation oncologists specializing in breast radiotherapy reviewed all cases. Advances in reconstruction to improve patient comfort such as gas or air-filled expanders, or pre-pectoral placement can create new challenges for optimal radiotherapy. Non-tissue equivalent, such as air, in a pre-pectoral expander can limit dose build up and compromise the dose planning algorithms and should be avoided in patients who will receive PMRT.
