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

155 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)553-564
Number of pages12
JournalInternational Journal of Radiation Oncology Biology Physics
Volume88
Issue number3
DOIs
StatePublished - Mar 1 2014
Externally publishedYes

Fingerprint

Radiation Oncology
Segmental Mastectomy
surgery
breast
margins
Ink
Breast
tumors
cancer
Guidelines
Breast Neoplasms
Recurrence
irradiation
radiation
inks
Neoplasms
biology
Carcinoma, Intraductal, Noninfiltrating
therapy
Cosmetics

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

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: International Journal of Radiation Oncology Biology Physics, Vol. 88, No. 3, 01.03.2014, p. 553-564.

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: International Journal of Radiation Oncology Biology Physics. 2014 ; Vol. 88, No. 3. pp. 553-564.
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abstract = "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.",
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