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.

@article{Moran2014SocietyOS,
  title={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.},
  author={M. Moran and S. Schnitt and A. Giuliano and Jay R. Harris and Seema A. Khan and J. Horton and S. Klimberg and M. Ch{\'a}vez-MacGregor and G. Freedman and N. Houssami and P. L. Johnson and M. Morrow},
  journal={Journal of clinical oncology : official journal of the American Society of Clinical Oncology},
  year={2014},
  volume={32 14},
  pages={
          1507-15
        }
}
  • M. Moran, S. Schnitt, +9 authors M. Morrow
  • Published 2014
  • Medicine
  • Journal of clinical oncology : official journal of the American Society of Clinical Oncology
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… Expand

Paper Mentions

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
  • M. Morrow, K. V. Van Zee, +10 authors M. Moran
  • Medicine
  • Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 2016
TLDR
The use of a 2 mm margin as the standard for an adequate margin in DCIS treated with WBRT is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcome, and decrease health care costs. Expand
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
TLDR
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. Expand
Close Margins Less Than 2 mm Are Not Associated With Higher Risks of 10-Year Local Recurrence and Breast Cancer Mortality Compared With Negative Margins in Women Treated With Breast-Conserving Therapy.
TLDR
The data support a policy of accepting carefully selected cases with close margins for adjuvant RT without re-excision, and do not endorse omitting re- Excision for all cases. Expand
Implications of New Lumpectomy Margin Guidelines for Breast-Conserving Surgery: Changes in Reexcision Rates and Predicted Rates of Residual Tumor
TLDR
Use of new lumpectomy margin guidelines would have reduced reoperation for BCT by half in this patient cohort, however, residual disease was present in many patients who would not have been reexcised with the new guidelines. Expand
Early Adoption of the SSO-ASTRO Consensus Guidelines on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Stage I and II Invasive Breast Cancer: Initial Experience from Memorial Sloan Kettering Cancer Center
TLDR
Close invasive margins were associated with higher rates of reexcision than negative invasive margins in both time periods; however, the effect diminished in the postguideline adoption period. Expand
Impact of the Society of Surgical Oncology-American Society for Radiation Oncology Margin Guidelines on Breast-Conserving Surgery and Mastectomy Trends.
TLDR
Repeat operation rates are decreasing after 2014, which is also associated with a rise in BCS and decrease in BM rates, and dissemination of margin guidelines for early-stage breast cancer might be impacting overall surgical trends. Expand
Margins in Breast-Conserving Surgery for Early Breast Cancer: How Much is Good Enough?
TLDR
Recommendations on a minimum margin width for ductal carcinoma in situ (DCIS) vary substantially from >1 to 10 mm or wider; evidence-based guidelines are being developed and are expected to address ‘how much is enough’ for margin width in DCIS. Expand
Is higher dose radiation necessary for positive resection margin after breast-conserving surgery for breast cancer?
TLDR
Among the patients with invasive carcinoma or DCIS within less than 1 mm from the resection margin, adjuvant RT with higher dose > 66Gy EQD2 might improve local control and validate the benefit and risk of a high dose boost after BCS in patients with a positive resectionmargin. Expand
Impact of Consensus Guidelines by the Society of Surgical Oncology and the American Society for Radiation Oncology on Margins for Breast-Conserving Surgery in Stages 1 and 2 Invasive Breast Cancer
TLDR
The consensus guidelines on margins for BCS were applied for 78 % of the patients who underwent re-excision and resulted in a significant reduction in re-Excision rates. Expand
Extent and Role of Margin Control for DCIS Managed by Breast-Conserving Surgery
TLDR
Important clinical and pathological factors that impact patient-specific margin management including the volume of DCIS near a margin, the anatomic location of close margins within the breast, the plan for adjuvant therapy, the appearance of a post-procedure mammogram, tissue handling, and margin assessment are reviewed. Expand
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 64 REFERENCES
Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy.
TLDR
Margin status has a prognostic effect in all women treated for invasive breast cancer; increasing the threshold distance for declaring negative margins is weakly associated with reduced odds of LR, however adjustment for covariates (adjuvant therapy) removes the significance of this effect. Expand
Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial.
TLDR
Young age and high-grade invasive ductal cancer were the most important risk factors for local relapse, while margin status had no significant influence. Expand
Factors determining outcome for breast-conserving irradiation with margin-directed dose escalation to the tumor bed.
TLDR
Graded tumor-bed dose escalation in response to FMS results in an exceptionally low risk of "early" local recurrence within the first 5 years of follow-up, however, this strategy is unable to completely overcome the longer term adverse influence of young age and positive FMS. Expand
Histologic multifocality of tis, T1–2 breast carcinomas implications for clinical trials of breast‐conserving surgery
TLDR
The expected rates of local recurrences after breast‐conserving surgical procedures relative to the extensiveness of the excision are estimated and the possible impact of postoperative local radiation therapy on the rates of expected local recurrence is discussed. Expand
Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials.
TLDR
Age no more than 35 years and the presence of an extensive intraductal component are associated with an increased risk of local recurrence after breast-conserving therapy and should therefore not be used for deciding between the two treatments. Expand
Presence of Lobular Carcinoma In Situ Does Not Increase Local Recurrence in Patients Treated with Breast-Conserving Therapy
TLDR
Findings do not support consideration of LCIS as a precursor to the development of invasive lesions, and menopausal status and adjuvant therapy use were significant predictors of LR. Expand
Radiotherapy boost dose-escalation for invasive breast cancer after breast-conserving surgery: 2093 patients treated with a prospective margin-directed policy.
  • L. Livi, I. Meattini, +13 authors G. Biti
  • Medicine
  • Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
  • 2013
TLDR
It was showed that a margin-directed policy of RT boost dose-escalation seems to reduce the negative impact of FMS on LR, but it is not able to overcome the unfavorable effect of higher nuclear grade, higher T stage and triple negative subtype. Expand
Influence of Margin Status on Outcomes in Lobular Carcinoma: Experience of the European Institute of Oncology
TLDR
The findings indicate that minimal residual disease as evidenced by margins less than 10 mm is eradicated by radiotherapy, and the surgical approach and criteria for adjuvant hormonal and systemic treatment in lobular carcinoma should be the same as for ductal carcinoma, provided that adequate preoperative investigations exclude extensive multifocal and contralateral disease. Expand
Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer.
TLDR
Although LRF is uncommon in patients with node-negative breast cancer who are treated with lumpectomy, radiation, and adjuvant systemic therapy, those who do develop LRF have substantially worse OS and DDFI than those with later-occurring LRF. Expand
Current Perceptions Regarding Surgical Margin Status After Breast-Conserving Therapy: Results of a Survey
TLDR
Significant variation in the perception of negative and close margins among radiation oncologists in NA and Europe is revealed and a universal definition of negative margins and consistent recommendations for reexcision are needed. Expand
...
1
2
3
4
5
...