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

Meena S. Moran, Stuart J. Schnitt, Armando E. Giuliano, Jay R. Harris, Seema A. Khan, Janet Horton, Vicki Klimberg, Mariana Chavez-Macgregor, Gary Freedman, Nehmat Houssami, Peggy L. Johnson, Monica Morrow

Research output: Contribution to journalArticle

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Abstract

Purpose: Controversy exists regarding the optimal margin width in breast-conserving surgery for invasive breast cancer. Methods: A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (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 two-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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)704-716
Number of pages13
JournalAnnals of Surgical Oncology
Volume21
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

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Radiation Oncology
Segmental Mastectomy
Ink
Breast
Guidelines
Breast Neoplasms
Recurrence
Neoplasms
Carcinoma, Intraductal, Noninfiltrating
Cosmetics
Health Care Costs
Meta-Analysis
Surgical Oncology
Radiation
Carcinoma
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

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. / Moran, Meena S.; Schnitt, Stuart J.; Giuliano, Armando E.; Harris, Jay R.; Khan, Seema A.; Horton, Janet; Klimberg, Vicki; Chavez-Macgregor, Mariana; Freedman, Gary; Houssami, Nehmat; Johnson, Peggy L.; Morrow, Monica.

In: Annals of Surgical Oncology, Vol. 21, No. 3, 03.2014, p. 704-716.

Research output: Contribution to journalArticle

Moran, Meena S. ; Schnitt, Stuart J. ; Giuliano, Armando E. ; Harris, Jay R. ; Khan, Seema A. ; Horton, Janet ; Klimberg, Vicki ; Chavez-Macgregor, Mariana ; Freedman, Gary ; Houssami, Nehmat ; Johnson, Peggy L. ; Morrow, Monica. / 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. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 3. pp. 704-716.
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abstract = "Purpose: Controversy exists regarding the optimal margin width in breast-conserving surgery for invasive breast cancer. Methods: A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (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 two-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. Conclusion: 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.",
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