CPB Ljubljana 2018 course book

• 33 studies 28,162 patients • Positive margins (ink on invasive carcinoma or DCIS) have 2-fold increase in the risk of IBTR. • This risk is not mitigated by Society of Surgical Oncology/ ASTRO Consensus Guideline on Margins for Breast-Conserving Surgery With Whole- Breast Irradiation in Stages I and II Invasive Breast Cancer

Society of Surgical Oncology– ASTRO–ASCO Consensus Guideline on Margins for Breast- Conserving Surgery with Whole breast irradiation in Ductal Carcinoma In Situ 7,883 patients • Positive margins (ink on DCIS) have 2-fold increase in the risk of IBRT. • A 2-mm margin minimizes the risk of IBTR • Negative margins <2 mm alone are not an indication for mastectomy. • 20 studies

favorable biology, endocrine therapy, or a radiation boost.

A higher dose of boost is needed Brachy boost is a good option

Moran MS et al. 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. Int J Radiation Oncol Biol Phys, 2014; 88 (3): 553-564,

Morrow M et al. 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. Ann Surg Oncol (2016) 23:3801-10