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I enjoyed the review article by Dr. Jeannie Shen (Community Oncology, December 2010), both for her succinct summary of the indications for postmastectomy plastic surgical reconstruction and the optimal timing of the procedure. Her salient presentation contained some of the most contemporary indications for postmastectomy radiotherapy (PMRT).

Along with the points Dr. Shen mentioned as indicators for PMRT— tumor size, regional nodal involvement, presence of lymphovascular space invasion, and patient youth—I would add estrogen receptor-negative disease as another tumor factor to consider for adjuvant radiotherapy. Many series, including some of those referenced by Dr. Shen and the American Society of Clinical Oncology in the composition of its recommendations, have demonstrated that estrogen receptor-negative status represents an independent risk factor for locoregionally recurrent disease after mastectomy and that the risk is significantly reduced by PMRT.^1–7 ...

* For a PDF of the full article, click in the link to the left of this introduction.