Medline ® Abstract for Reference 49
of 'Breast conserving therapy'
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 MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, Klimberg S, Chavez-MacGregor M, Freedman G, Houssami N, Johnson PL, Morrow M, Society of Surgical Oncology, American Society for Radiation Oncology
J Clin Oncol. 2014 May;32(14):1507-15. Epub 2014 Feb 10.
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 IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins 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.
CONCLUSION: 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. J Clin Oncol 32. 2014 American Society of Clinical Oncology®, American Society for Radiation Oncology®, and Society of Surgical Oncology®. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology.
Meena S. Moran, Yale University School of Medicine, New Haven, CT; Stuart J. Schnitt and Jay R. Harris, Harvard Medical School, Boston, MA; Armando E. Giuliano, Cedars Sinai Medical Center, Los Angeles, CA; Seema A. Khan, Northwestern University Feinberg School of Medicine, Chicago, IL; Janet Horton, Duke University Medical Center, Durham, NC; Suzanne Klimberg, University of Arkansas for Medical Sciences, Fayetteville, AR; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Gary Freedman, University of Pennsylvania School of Medicine, Philadelphia, PA; Nehmat Houssami, School of Public Health, University of Sydney Medical School, Sydney, New South Wales, Australia; Peggy L. Johnson, Susan G. Komen Advocate in Science, Wichita, KS; and Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY.