Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ Journal Article

   

Authors:	Morrow, M.; Van Zee, K. J.; Solin, L. J.; Houssami, N.; Chavez-MacGregor, M.; Harris, J. R.; Horton, J.; Hwang, S.; Johnson, P. L.; Marinovich, M. L.; Schnitt, S. J.; Wapnir, I.; Moran, M. S.
Article Title:	Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ
Abstract:	Purpose: Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation. Methods: A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 20 studies including 7,883 patients and other published literature as the evidence base for consensus. Results: Negative margins halve the risk of IBTR compared with positive margins defined as ink on DCIS. A 2-mm margin minimizes the risk of IBTR compared with smaller negative margins. More widely clear margins do not significantly decrease IBTR compared with 2-mm margins. Negative margins narrower than 2 mm alone are not an indication for mastectomy, and factors known to affect rates of IBTR should be considered in determining the need for re-excision. Conclusion: Use of a 2-mm margin as the standard for an adequate margin in DCIS treated with whole-breast irradiation is associated with lower rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins narrower than 2 mm. © 2016, American Society of Clinical Oncology, Society of Surgical Oncology, and American Society for Radiation Oncology.
Keywords:	excision; review; cancer radiotherapy; treatment indication; practice guideline; cancer hormone therapy; systematic review; tumor recurrence; partial mastectomy; clinical decision making; intraductal carcinoma; randomized controlled trial (topic); meta analysis (topic); tumor invasion; whole breast irradiation; human; female
Journal Title:	Annals of Surgical Oncology
Volume:	23
Issue:	12
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2016-11-01
Start Page:	3801
End Page:	3810
Language:	English
DOI:	10.1245/s10434-016-5449-z
PROVIDER:	scopus
PMCID:	PMC5047939
PUBMED:	27527714
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-84982156350&partnerID=40&md5=f154ab266ffc837e687421b36b69a1ed
Notes:	Review -- Export Date: 1 November 2016 -- Source: Scopus

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