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 and materials: 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 7883 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. (C) 2016 Published by Elsevier Inc. on behalf of the American Society for Radiation Oncology.
Keywords:	excision; radiotherapy; risk; women; phase-iii trial; randomized-trial; long-term outcomes; recurrence rates; cancer; dcis trial
Journal Title:	Practical Radiation Oncology
Volume:	6
Issue:	5
ISSN:	1879-8519
Publisher:	Elsevier Inc.
Date Published:	2016-09-01
Start Page:	287
End Page:	295
Language:	English
ACCESSION:	WOS:000386887900012
DOI:	10.1016/j.prro.2016.06.011
PROVIDER:	wos
PMCID:	PMC5070537
PUBMED:	27538810
Notes:	Article -- Source: Wos

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