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Later there was a change in view of the natural history of the disease from localized in some patients to systemic in all patients [2]. Several meta-analysis by Stjernsward in the 1970s [3-5] and Cuzick et al. [6] in the 1980s and the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) [7] in the 1990s suggested decreased survival in patients randomized to PMRT. Updates of these meta-analyses in 1994 and 2000 questioned this conclusion based on cause-specific analyses [8,9] Two large Danish randomized trials (1997) examined the role of PMRT in high risk women with breast cancer treated by mastectomy and adjuvant chemotherapy [10-12]. They showed a significant decrease in local recurrence, disease specific mortality, and overall mortality at 10 and 15 years with PMRT thus proving that loco regional disease control is critical to improving survival.

"Risk Factors and Treatment Outcome In Node- Negative Breast Cancer Patients With Tumors Five Cm and Larger, Impact of Pmrt"