Optimising radiation treatment decisions for patients who receive neoadjuvant chemotherapy and mastectomy.

Whereas randomised clinical trials have established which patients might benefit from postmastectomy radiation therapy after upfront surgery, no such data exist for guiding decisions on who might benefit from postmastectomy radiation therapy after upfront chemotherapy. Insight must be drawn from non-randomised data to provide such guidance. Early data suggest that both extent of disease at presentation and response to neoadjuvant chemotherapy predict the risk of locoregional recurrence, and can be used to tailor recommendations for postmastectomy radiation therapy. Randomised clinical trial data are needed to assess whether postmastectomy radiation therapy can be safely omitted in selected women with good response to neoadjuvant chemotherapy.