American Radium Society® Appropriate Use Criteria POSTMASTECTOMY RADIOTHERAPY: Executive Summary of Clinical Topics.

Most patients with even limited nodal involvement will likely benefit from PMRT with significant reduction in LRR and potential survival benefit. Patients with initial clinical stage III disease and/or any residual disease after NAC should be strongly considered for PMRT. Growing evidence supports the use of hypofractionated radiation for PMRT with equivalent efficacy and decreased acute side effects, with additional evidence is needed for special populations. There is limited evidence to support routine use of bolus in all patients. Timing of PMRT in regards to completion of two-staged breast reconstruction requires a discussion of increased risks with radiation post-implant exchange compared to increased risk of failure of reconstruction or surgical complications with radiation pre-implant exchange.