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

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

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.

Related collections

Most cited references 36

Record: found
Abstract: found
Article: not found

Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS.

J Dignam, Richard G Margolese, Bernard Fisher … (2011)

Ipsilateral breast tumor recurrence (IBTR) is the most common failure event after lumpectomy for ductal carcinoma in situ (DCIS). We evaluated invasive IBTR (I-IBTR) and its influence on survival among participants in two National Surgical Adjuvant Breast and Bowel Project (NSABP) randomized trials for DCIS. In the NSABP B-17 trial (accrual period: October 1, 1985, to December 31, 1990), patients with localized DCIS were randomly assigned to the lumpectomy only (LO, n = 403) group or to the lumpectomy followed by radiotherapy (LRT, n = 410) group. In the NSABP B-24 double-blinded, placebo-controlled trial (accrual period: May 9, 1991, to April 13, 1994), all accrued patients were randomly assigned to LRT+ placebo, (n=900) or LRT + tamoxifen (LRT + TAM, n = 899). Endpoints included I-IBTR, DCIS-IBTR, contralateral breast cancers (CBC), overall and breast cancer-specific survival, and survival after I-IBTR. Median follow-up was 207 months for the B-17 trial (N = 813 patients) and 163 months for the B-24 trial (N = 1799 patients). Of 490 IBTR events, 263 (53.7%) were invasive. Radiation reduced I-IBTR by 52% in the LRT group compared with LO (B-17, hazard ratio [HR] of risk of I-IBTR = 0.48, 95% confidence interval [CI] = 0.33 to 0.69, P < .001). LRT + TAM reduced I-IBTR by 32% compared with LRT + placebo (B-24, HR of risk of I-IBTR = 0.68, 95% CI = 0.49 to 0.95, P = .025). The 15-year cumulative incidence of I-IBTR was 19.4% for LO, 8.9% for LRT (B-17), 10.0% for LRT + placebo (B-24), and 8.5% for LRT + TAM. The 15-year cumulative incidence of all contralateral breast cancers was 10.3% for LO, 10.2% for LRT (B-17), 10.8% for LRT + placebo (B-24), and 7.3% for LRT + TAM. I-IBTR was associated with increased mortality risk (HR of death = 1.75, 95% CI = 1.45 to 2.96, P < .001), whereas recurrence of DCIS was not. Twenty-two of 39 deaths after I-IBTR were attributed to breast cancer. Among all patients (with or without I-IBTR), the 15-year cumulative incidence of breast cancer death was 3.1% for LO, 4.7% for LRT (B-17), 2.7% for LRT + placebo (B-24), and 2.3% for LRT + TAM. Although I-IBTR increased the risk for breast cancer-related death, radiation therapy and tamoxifen reduced I-IBTR, and long-term prognosis remained excellent after breast-conserving surgery for DCIS.

0 comments Cited 166 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ.

Steven A. Narod, Javaid Iqbal, Vasily Giannakeas … (2015)

Women with ductal carcinoma in situ (DCIS), or stage 0 breast cancer, often experience a second primary breast cancer (DCIS or invasive), and some ultimately die of breast cancer.

0 comments Cited 165 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast.

Michael Gnant (2010)

Individual patient data were available for all four of the randomized trials that began before 1995, and that compared adjuvant radiotherapy vs no radiotherapy following breast-conserving surgery for ductal carcinoma in situ (DCIS). A total of 3729 women were eligible for analysis. Radiotherapy reduced the absolute 10-year risk of any ipsilateral breast event (ie, either recurrent DCIS or invasive cancer) by 15.2% (SE 1.6%, 12.9% vs 28.1% 2 P <.00001), and it was effective regardless of the age at diagnosis, extent of breast-conserving surgery, use of tamoxifen, method of DCIS detection, margin status, focality, grade, comedonecrosis, architecture, or tumor size. The proportional reduction in ipsilateral breast events was greater in older than in younger women (2P < .0004 for difference between proportional reductions; 10-year absolute risks: 18.5% vs 29.1% at ages <50 years, 10.8% vs 27.8% at ages ≥ 50 years) but did not differ significantly according to any other available factor. Even for women with negative margins and small low-grade tumors, the absolute reduction in the 10-year risk of ipsilateral breast events was 18.0% (SE 5.5, 12.1% vs 30.1%, 2P = .002). After 10 years of follow-up, there was, however, no significant effect on breast cancer mortality, mortality from causes other than breast cancer, or all-cause mortality.

0 comments Cited 153 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Monica Morrow: 646 888 5350 , morrowm@mskcc.org

Kimberly J. Van Zee:

ORCID: http://orcid.org/0000-0001-9550-4647

vanzeek@mskcc.org

Lawrence J. Solin: solin@einstein.edu

Nehmat Houssami: nehmat.houssami@sydney.edu.au

Mariana Chavez-MacGregor: mchavezm@mdanderson.org

Jay R. Harris: jharris@lroc.harvard.edu

Janet Horton: janet.horton@duke.edu

Shelley Hwang: shelley.hwang@duke.edu

Peggy L. Johnson: pjohnson@wmref-ks.org

M. Luke Marinovich: luke.marinovich@sydney.edu.au

Stuart J. Schnitt: sschnitt@bidmc.harvard.edu

Irene Wapnir: wapnir@stanford.edu

Meena S. Moran: meena.moran@yale.edu

Journal

Journal ID (nlm-ta): Ann Surg Oncol

Journal ID (iso-abbrev): Ann. Surg. Oncol

Title: Annals of Surgical Oncology

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1068-9265

ISSN (Electronic): 1534-4681

Publication date (Electronic): 15 August 2016

Publication date PMC-release: 15 August 2016

Publication date (Print): 2016

Volume: 23

Issue: 12

Pages: 3801-3810

Affiliations

[1 ]Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY USA

[2 ]Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, PA USA

[3 ]Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW Australia

[4 ]Departments of Medical Oncology and Health Service Research, University of Texas MD Anderson Cancer Center, Houston, TX USA

[5 ]Department of Radiation Oncology, Harvard Medical School, Boston, MA USA

[6 ]Department of Radiation Oncology, Duke University Medical Center, Durham, NC USA

[7 ]Department of Surgery, Duke University Medical Center, Durham, NC USA

[8 ]Advocate in Science, Susan G. Komen, Kansas City, USA

[9 ]Department of Pathology, Harvard Medical School, Boston, MA USA

[10 ]Department of Surgery, Stanford University School of Medicine, Stanford, CA USA

[11 ]Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, CT USA

Author information

Kimberly J. Van Zee http://orcid.org/0000-0001-9550-4647

Article

Publisher ID: 5449

DOI: 10.1245/s10434-016-5449-z

PMC ID: 5047939

PubMed ID: 27527714

SO-VID: 74869968-d99d-4290-a836-5696eae18487

History

Date received : 28 April 2016

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Comments

Comment on this article

scite_

Cited by 53

See all cited by

Most referenced authors 412

See all reference authors

- Version 1
- Version 1

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

Read this article at

Abstract

Purpose

Methods

Results

Conclusion

Related collections

Karger: Oncology

Most cited references 36

Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS.

Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ.

Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 73

Cited by 53

Most referenced authors 412