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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2014

01-03-2014 | Breast Oncology – Special Article

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

Authors: Meena S. Moran, MD, Stuart J. Schnitt, MD, Armando E. Giuliano, MD, Jay R. Harris, MD, Seema A. Khan, MD, Janet Horton, MD, Suzanne Klimberg, MD, Mariana Chavez-MacGregor, MD, Gary Freedman, MD, Nehmat Houssami, MD, PhD, Peggy L. Johnson, Monica Morrow, MD

Published in: Annals of Surgical Oncology | Issue 3/2014

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Abstract

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 than no ink on tumor 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.
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Metadata
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
Authors
Meena S. Moran, MD
Stuart J. Schnitt, MD
Armando E. Giuliano, MD
Jay R. Harris, MD
Seema A. Khan, MD
Janet Horton, MD
Suzanne Klimberg, MD
Mariana Chavez-MacGregor, MD
Gary Freedman, MD
Nehmat Houssami, MD, PhD
Peggy L. Johnson
Monica Morrow, MD
Publication date
01-03-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 3/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3481-4

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