When evaluating margin status to consider APBI for early stage invasive breast cancer, given the specification for at least 2mm margins, do you look at the DCIS margin or only the invasive margin?

Topics: Breast Cancer • Radiation Oncology

Additionally, when evaluating margin status for APBI IMRT 30 Gy in 5 fractions which specifies at least 5mm margins, do you look at the DCIS margin or only the invasive margin?

Answer from: Radiation Oncologist at Academic Institution

I take a slightly different approach. Current guidelines for breast conserving surgery allow for no tumor on ink for invasive cancers, even those with DCIS associated. While ASTRO guidelines recommend 2 mm for APBI (Correa et al., PMID 27866865), other guidelines such as the ABS do not for invasive ...

Answer from: Radiation Oncologist at Academic Institution

I would always consider both. DCIS recurrence rates after radiation (NSABP for example) have always been higher than for invasive cancer. Microinvasive cancer will often have recurrence rates similar to DCIS. Silverstein published his results in his articles and book based on close pathological eva...

Radiation Oncologist

Great question! I agree that both Invasive and DCIS margins are important and must be considered. Regarding the more recently published Livi 5 fractioned APBI, personal and institutional eligibility criteria are preferential.However, anytime I adopt a new protocol for my clinic, I think it is invalu...

Comments

Radiation Oncologist at Kaiser Permanente
Many of these patients are over 65 and may be cand...

Radiation Oncologist at Cleveland Clinic
I would agree with you. Also, I have more patients...

Radiation Oncologist at Northeast Alabama Regional Medical Center
Dr. @Thomas D. Wynne has a good point. Also this w...

Radiation Oncologist at Cleveland Clinic
I tend to be comfortable with PBI with otherwise l...

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