Conservative Surgery and Radiation Stage I and II Breast Cancer Variant 1: Premenopausal 41-year-old woman, 1.1-cm GII IDC, upper outer quadrant (UOQ), ER/PR ( ), HER2 ( ), primary excised with lumpectomy, margins ( ), SN biopsy negative, BRCA1 mutation positive. Procedure Partial breast irradiation Whole breast irradiation + contralateral mastectomy Appropriateness Category not SOE RRL Panel Rating Group Median Rating Final Tabulations 1 2 3 4 5 6 7 8 9 TBD TBD TBD TBD Variant 2: Postmenopausal 56-year-old woman, 2.5-cm UOQ moderately differentiated, EIC present, SN ( ), ER/PR ( ), HER2 ( ), primary excised with lumpectomy, 1 focus of margin involvement; chemotherapy and antiendocrine therapy planned. Re-excision + whole breast RT if negative margins +/- boost TBD TBD
No further surgery + RT to 66 Gy (33 fractions) No further surgery + RT to 60 Gy (30 fractions) not 5 n/a 0 0 0 0 0 0 0 0 0 3 n/a 0 0 0 0 0 0 0 0 0 Variant 3: Premenopausal 46-year-old woman, 2.6-cm UOQ IDC, primary excised with lumpectomy, margins ( ), minimal DCIS, 2/10 LNs ( ), level I-II axillary node dissection, ER/PR ( ), HER2 ( ), BRCA ( ), chemotherapy planned, patient desires breast conservation. Full axilla (level I-III) Supraclavicular + apical (level III) axillary nodes Whole breast RT + nodal RT Whole breast RT alone Internal mammary nodes (IMN) not not TBD TBD TBD TBD 7 n/a 0 0 0 0 0 0 0 0 0 TBD TBD TBD TBD 4 n/a 0 0 0 0 0 0 0 0 0
Whole breast: 45 50 Gy (23 25 fractions) (no boost) Whole breast: 40 42.6 Gy (15 16 fractions) + 10 Gy boost Whole breast: 40 42.6 Gy (15 16 fractions) (no boost) Whole breast + tumor bed dose: 60 66 Gy (30 33 fractions) Supraclavicular ± axillary apex: 45 50 Gy (23 25 fractions) IMN: 45 50 Gy (23 25 fractions) not not 4 n/a 0 0 0 0 0 0 0 0 0 Variant 4: Healthy 70-year-old woman, 0.5-cm well-differentiated IDC, ER/PR ( ), HER2 ( ), left-sided primary excised with lumpectomy, margins ( ) <2 mm; endocrine therapy planned. node biopsy + accelerated PBI node biopsy + whole breast RT Mastectomy + sentinel lymph node biopsy TBD TBD TBD TBD
node biopsy (no RT, no endocrine therapy) not Whole breast: 45 50 Gy (23 25 fractions) Whole breast: 40 42.5 Gy (15 16 fractions) Whole breast + tumor bed boost: 64 66 Gy (32 33 fractions) 7 n/a 0 0 0 0 0 0 0 0 0 Whole breast + tumor bed boost: 60 Gy (30 fractions) Total tumor bed dose: 50 Gy PBI: 34 38.5 Gy (8 10 fractions over 5 days) 7 n/a 0 0 0 0 0 0 0 0 0 node biopsy (no RT) TBD TBD 7 n/a 0 0 0 0 0 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below. Final Tabulations: A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, etc.) Disagree: The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation. : Lists the references associated with the recommendation. SQ: (1, 2, 3, 4, Good M or Inadequate M) of the references listed. RRL: Information on the Relative Radiation Level (RRL) designations can be found.