What are the guidelines for breast-conserving surgery with whole-breast radiation therapy (WBRT) in stages I and II invasive breast cancer?

Updated: Sep 23, 2020
  • Author: Pavani Chalasani, MD, MPH; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

The following consensus guideline, released in 2014 by the Society of Surgical Oncology and the American Society for Radiation Oncology, addresses margins for breast-conserving surgery with whole-breast irradiation (WBI) in stages I and II invasive breast cancer. [194] :

  • Positive margins are associated with at least a two-fold increase in ipsilateral breast tumor recurrence (IBTR)

  • Negative margins optimize IBTR; this risk is not significantly lowered by wider margin widths

  • IBTR rates are reduced with the use of systemic therapy; in patients who do not receive adjuvant systemic therapy, margins wider than no ink on tumor are not needed

  • Biologic subtypes do not indicate the need for margins wider than no ink on tumor

  • Margin width should not determine the choice of WBI delivery technique, fractionation, and boost dose

  • Wider negative margins than no ink on tumor are not indicated for patients with invasive lobular cancer; classic lobular carcinoma in situ (LCIS) at the margin is not an indication for reexcision; the significance of pleomorphic LCIS at the margin is not clear

  • Young age is associated with an increased risk for IBTR after breast-conserving therapy, an increased risk for local relapse on the chest wall after mastectomy, and adverse biologic and pathologic features; an increased margin width does not nullify the increased risk for IBTR in young patients

  • An extensive intraductal component (EIC) identifies patients who may have a large residual ductal carcinoma in situ (DCIS) burden after lumpectomy; when margins are negative, there is no evidence of an association between an increased risk for IBTR and EIC


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