Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

Journal Article · Sat Mar 01 04:00:00 EST 2014 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2013.11.012· OSTI ID:22416455

Moran, Meena S. ^[1]; Schnitt, Stuart J. ^[2]; Giuliano, Armando E. ^[3]; Harris, Jay R. ^[4]; Khan, Seema A. ^[5]; Horton, Janet ^[6]; Klimberg, Suzanne ^[7]; Chavez-MacGregor, Mariana ^[8]; Freedman, Gary ^[9]; Houssami, Nehmat ^[10]; Johnson, Peggy L. ^[11]; Morrow, Monica ^[12]

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1. Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (United States)
2. Department of Pathology, Harvard Medical School, Boston, Massachusetts (United States)
3. Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California (United States)
4. Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States)
5. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois (United States)
6. Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)
7. Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, Arkansas (United States)
8. Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
9. Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (United States)
10. School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales (Australia)
11. Advocate in Science, Susan G. Komen, Wichita, Kansas (United States)
12. Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

• OSTI ID: 22416455
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 88; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
MAMMARY GLANDS
PATIENTS
RADIOTHERAPY
REVIEWS
SAFETY MARGINS
SURGERY