What are the guidelines for breast-conserving surgery with whole-breast radiation therapy (WBRT) in ductal carcinoma in situ (DCIS) breast cancer?

Updated: Dec 27, 2019
  • Author: Pavani Chalasani, MD, MPH; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

In 2016, the Society of Surgical Oncology, American Society for Radiation Oncology and American Society of Clinical Oncology released a consensus guideline that addresses margins for breast-conserving surgery with whole-breast radiation therapy (WBRT) in ductal carcinoma in situ (DCIS). Key recommendations include [185] :

  • A positive margin is associated with a significant increase in ipsilateral breast tumor recurrence (IBTR); this increased risk is not nullified by the use of WBRT
  • Negative margins halve the risk of IBTR  and a 2 mm margin minimizes the risk of IBTR compared with smaller negative margins.
  • More widely clear margins do not significantly decrease IBTR compared with 2 mm margins.
  • Negative margins < 2 mm alone are not an indication for mastectomy; clinical judgment should be used in determining the need for further surgery in patients with negative margins < 2 mm.

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