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

210 Citations (Scopus)

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 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)1507-1515
Number of pages9
JournalJournal of Clinical Oncology
Volume32
Issue number14
DOIs
StatePublished - May 10 2014
Externally publishedYes

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

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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: Journal of Clinical Oncology, Vol. 32, No. 14, 10.05.2014, p. 1507-1515.

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: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 14. pp. 1507-1515.
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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 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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