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

Abstract

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. J Clin Oncol 32. 2014 American Society of Clinical Oncology®, American Society for Radiation Oncology®, and Society of Surgical Oncology®. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology.

Pattern of relapse after breast conserving therapy, a study of 1519 early breast cancer patients treated in the Central Region of Denmark 2000–2009

“…In spite of a relatively low number of patients receiving boost (29%), we did observe DFS in line with recent studies, and have previously published result reporting corresponding low risks of IBTR [23]. In the recent ASTRO guidelines [4], it is not recommended to base the use of boost on the margin width. However, in the meta-analysis by Houssami et al [5] 96% of the patients received boost, and although only 29% of all patients in the current study received boost, 96% of those with margins <2 mm did.…”

“…The importance of margin width in development of DM is less well established, although recent guidelines recommend a standard margin width of no tumor on ink after BCT [4], as no benefit in local control has been shown with wider free margins [5].…”

General St. Gallen-2015 guidelines for the treatment of early breast cancer (adapted by the experts of the Russian Society of Breast Oncologists)

“…Метаанализ исследований хирургического лечения не показал дальнейшей выгоды при достижении более широких «чистых» краев резекции, чем «отсутствие красителя на опухоли» [29]. Этот вывод применим независимо от характеристик опухоли, таких как дольковый гистотип рака, обширный внутрипротоковый компонент, молодой возраст или неблагоприятный биологический подтип [6]. Как было показано в ряде крупных исследований, у женщин с опухолями T1-2 и клинически негативны-ми ЛУ (cN0) отказ от подмышечной лимфаденэктомии при наличии макрометастазов в 1 или 2 ЛУ [30,31] оказался безопасным [32].…”

“…Всплыл странный парадокс в обоснова-нии локальных видов лечения. Что касается хирурги-ческого лечения, то здесь продолжается тенденция к менее экстенсивной (органосохраняющей) хирур-гии, приводящей к благоприятным исходам [6]. Но метаанализ 3 недавно проведенных клинических испытаний лучевой терапии у N-позитивных пациен-тов выявил превосходство местного контроля заболе-вания и выживаемости при расширении полей ради-ации, включающих зоны регионарных лимфатических узлов (ЛУ) [7].…”

DCIS does not need treatment… really?

“…Based on this, I was content with margins of ''no ink on tumor'' for the rest of the 1980s and early 1990s, but owing to varying opinions of the community at large [10] and local custom, I did 1 mm in the late 1990s and 2 mm in the early 2000s. In 2014, the consensus guidelines on resection margins for invasive cancer were published in the Journal of Clinical Oncology [11]. The consensus stated that ''no ink on tumor'' was sufficient for invasive cancer, which is once again my standard practice.…”