Abstract
Randomized trials have clearly established breast conservation therapy (BCT) as appropriate treatment for early-stage invasive breast cancer. Current evidence shows that positive margins confer a greater than twofold risk of ipsilateral breast tumor recurrence. Thus, patients who have positive margins after BCT warrant re-excision. With regard to negative margins, however, the optimal negative margin width remains unclear. This article reviews the recent guidelines set forth by the Society of Surgical Oncology and the American Society of Radiation Oncology regarding the margin width in stage I and II invasive breast cancer. We also discuss the controversies related to implementation of these guidelines.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Early Breast Cancer Trialists’ Collaborative Group, Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707–16.
Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989;320:822–8.
Winchester DP, Cox JD. Standards for diagnosis and management of invasive breast carcinoma. American College of Radiology. American College of Surgeons College of American Pathologists Society of Surgical Oncology. CA Cancer J Clin. 1998;48:83–107.
Litiere S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage I–II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol. 2012;13:412–9. This article confirms, over a 20 year follow-up, that breast conservation therapy is equivalent to mastectomy in terms of time to distant metastasis and survival.
Arriagada R, Le MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol Off J Am Soc Clin Oncol. 1996;14:1558–64.
Black DM, Hunt KK, Mittendorf EA. Long term outcomes reporting the safety of breast conserving therapy compared to mastectomy: 20-year results of EORTC 10801. Gland Surg. 2013;2:120–3.
McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307:467–75.
Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21:717–30. This article reviews the data from the meta-analysis that led to the guidelines set forth by the Society of Surgical Oncology and the American Society of Radiology regarding optimal margin widths in breast conservation therapy in patients with stage I and II invasive breast cancer.
Moran MS, Schnitt SJ, Giuliano AE, 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. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32:1507–15. This article outlines the guidelines set forth by the Society of Surgical Oncology and the American Society for Radiation Oncology regarding optimal margin widths in breast conservation therapy in patients with stage I and II invasive breast cancer.
Buchholz TA, Somerfield MR, Griggs JJ, et al. Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32:1502–6.
Jagsi R, Smith BD, Sabel M, Pierce L. Individualized, patient-centered application of consensus guidelines to improve the quality of breast cancer care. Int J Radiat Oncol Biol Phys. 2014;88:535–6.
Hunt KK, Sahin AA. Too much, too little, or just right? Tumor margins in women undergoing breast-conserving surgery. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32:1401–6.
Dunne C, Burke JP, Morrow M, Kell MR. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol Off J Am Soc Clin Oncol. 2009;27:1615–20.
Wang SY, Chu H, Shamliyan T, et al. Network meta-analysis of margin threshold for women with ductal carcinoma in situ. J Natl Cancer Inst. 2012;104:507–16.
Compliance with Ethics Guidelines
Conflict of Interest
Ava Hosseini, Bindupriya Chandrasekaran, Rebecca Aft, and Sarah Blair declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Local-Regional Evaluation and Therapy
Rights and permissions
About this article
Cite this article
Hosseini, A., Chandrasekaran, B., Aft, R. et al. Optimal Margin Width in Breast Conservation Therapy: a Review of the Current Guidelines and Literature. Curr Breast Cancer Rep 7, 48–52 (2015). https://doi.org/10.1007/s12609-014-0170-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12609-014-0170-z