Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update

2016 ◽  
Vol 6 (6) ◽  
pp. e219-e234 ◽  
Author(s):  
Abram Recht ◽  
Elizabeth A. Comen ◽  
Richard E. Fine ◽  
Gini F. Fleming ◽  
Patricia H. Hardenbergh ◽  
...  
Keyword(s):  
Clinical Oncology ◽  
Radiation Oncology ◽  
Surgical Oncology ◽  
Postmastectomy Radiotherapy ◽  
American Society

scholarly journals Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update

2016 ◽  
Vol 24 (1) ◽  
pp. 38-51 ◽  
Author(s):  
Abram Recht ◽  
Elizabeth A. Comen ◽  
Richard E. Fine ◽  
Gini F. Fleming ◽  
Patricia H. Hardenbergh ◽  
...  
Keyword(s):  
Clinical Oncology ◽  
Radiation Oncology ◽  
Surgical Oncology ◽  
Postmastectomy Radiotherapy ◽  
American Society

Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update

2016 ◽  
Vol 34 (36) ◽  
pp. 4431-4442 ◽  
Author(s):  
Abram Recht ◽  
Elizabeth A. Comen ◽  
Richard E. Fine ◽  
Gini F. Fleming ◽  
Patricia H. Hardenbergh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Oncology ◽  
Radiation Oncology ◽  
Breast Cancer Mortality ◽  
Surgical Oncology ◽  
Sufficient Information ◽  
Postmastectomy Radiotherapy ◽  
Axillary Nodes ◽  
Neoadjuvant Systemic Therapy ◽  
American Society

Purpose A joint American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology panel convened to develop a focused update of the American Society of Clinical Oncology guideline concerning use of postmastectomy radiotherapy (PMRT). Methods A recent systematic literature review by Cancer Care Ontario provided the primary evidentiary basis. The joint panel also reviewed targeted literature searches to identify new, potentially practice-changing data. Recommendations The panel unanimously agreed that available evidence shows that PMRT reduces the risks of locoregional failure (LRF), any recurrence, and breast cancer mortality for patients with T1-2 breast cancer with one to three positive axillary nodes. However, some subsets of these patients are likely to have such a low risk of LRF that the absolute benefit of PMRT is outweighed by its potential toxicities. In addition, the acceptable ratio of benefit to toxicity varies among patients and physicians. Thus, the decision to recommend PMRT requires a great deal of clinical judgment. The panel agreed clinicians making such recommendations for individual patients should consider factors that may decrease the risk of LRF, attenuate the benefit of reduced breast cancer–specific mortality, and/or increase risk of complications resulting from PMRT. When clinicians and patients elect to omit axillary dissection after a positive sentinel node biopsy, the panel recommends that these patients receive PMRT only if there is already sufficient information to justify its use without needing to know additional axillary nodes are involved. Patients with axillary nodal involvement after neoadjuvant systemic therapy should receive PMRT. The panel recommends treatment generally be administered to both the internal mammary nodes and the supraclavicular-axillary apical nodes in addition to the chest wall or reconstructed breast.

Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update Summary

2016 ◽  
Vol 12 (12) ◽  
pp. 1258-1261 ◽  
Author(s):  
Abram Recht ◽  
Mark R. Somerfield ◽  
Stephen B. Edge
Keyword(s):  
Clinical Oncology ◽  
Radiation Oncology ◽  
Surgical Oncology ◽  
Axillary Lymph ◽  
Postmastectomy Radiotherapy ◽  
Regional Nodal Irradiation ◽  
Ongoing Controversy ◽  
Node Biopsy ◽  
Neoadjuvant Systemic Therapy ◽  
American Society

The American Society of Clinical Oncology guideline for the use of postmastectomy radiotherapy (PMRT) was published in 2001. This update of that guideline, completed in collaboration with the American Society for Radiation Oncology and the Society of Surgical Oncology, focuses on key areas of ongoing controversy, including the use of PMRT for patients with one to three positive lymph nodes, use of PMRT for patients undergoing neoadjuvant systemic therapy, and selected technical aspects of PMRT, particularly the extent of regional nodal irradiation. The question of whether PMRT is indicated in women with T1-2 tumors and a positive sentinel node biopsy who do not undergo completion axillary lymph node dissection is also discussed.

scholarly journals Management of Hereditary Breast Cancer: American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Guideline

2020 ◽  
Vol 38 (18) ◽  
pp. 2080-2106 ◽  
Author(s):  
Nadine M. Tung ◽  
Judy C. Boughey ◽  
Lori J. Pierce ◽  
Mark E. Robson ◽  
Isabelle Bedrosian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Clinical Oncology ◽  
Radiation Oncology ◽  
Single Agent ◽  
Significant Risk ◽  
Surgical Oncology ◽  
Bilateral Mastectomy ◽  
Eligibility Criteria ◽  
American Society

PURPOSE To develop recommendations for management of patients with breast cancer (BC) with germline mutations in BC susceptibility genes. METHODS The American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology convened an Expert Panel to develop recommendations based on a systematic review of the literature and a formal consensus process. RESULTS Fifty-eight articles met eligibility criteria and formed the evidentiary basis for the local therapy recommendations; six randomized controlled trials of systemic therapy met eligibility criteria. RECOMMENDATIONS Patients with newly diagnosed BC and BRCA1/ 2 mutations may be considered for breast-conserving therapy (BCT), with local control of the index cancer similar to that of noncarriers. The significant risk of a contralateral BC (CBC), especially in young women, and the higher risk of new cancers in the ipsilateral breast warrant discussion of bilateral mastectomy. Patients with mutations in moderate-risk genes should be offered BCT. For women with mutations in BRCA1/ 2 or moderate-penetrance genes who are eligible for mastectomy, nipple-sparing mastectomy is a reasonable approach. There is no evidence of increased toxicity or CBC events from radiation exposure in BRCA1/ 2 carriers. Radiation therapy should not be withheld in ATM carriers. For patients with germline TP53 mutations, mastectomy is advised; radiation therapy is contraindicated except in those with significant risk of locoregional recurrence. Platinum agents are recommended versus taxanes to treat advanced BC in BRCA carriers. In the adjuvant/neoadjuvant setting, data do not support the routine addition of platinum to anthracycline- and taxane-based chemotherapy. Poly (ADP-ribose) polymerase (PARP) inhibitors (olaparib and talazoparib) are preferable to nonplatinum single-agent chemotherapy for treatment of advanced BC in BRCA1/ 2 carriers. Data are insufficient to recommend PARP inhibitor use in the early setting or in moderate-penetrance carriers. Additional information available at www.asco.org/breast-cancer-guidelines .

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

2014 ◽  
Vol 32 (14) ◽  
pp. 1507-1515 ◽  
Author(s):  
Meena S. Moran ◽  
Stuart J. Schnitt ◽  
Armando E. Giuliano ◽  
Jay R. Harris ◽  
Seema A. Khan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Oncology ◽  
Invasive Breast Cancer ◽  
Radiation Oncology ◽  
Young Patients ◽  
Surgical Oncology ◽  
Breast Conserving Surgery ◽  
Margin Width ◽  
Increased Risk ◽  
American Society

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 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. J Clin Oncol 32. 2014 American Society of Clinical Oncology®, American Society for Radiation Oncology®, and Society of Surgical Oncology®. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology.

Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update

2018 ◽  
Vol 36 (4) ◽  
pp. 399-413 ◽  
Author(s):  
Sandra L. Wong ◽  
Mark B. Faries ◽  
Erin B. Kennedy ◽  
Sanjiv S. Agarwala ◽  
Timothy J. Akhurst ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Clinical Oncology ◽  
Surgical Oncology ◽  
Breslow Thickness ◽  
Clinicopathological Factors ◽  
Careful Observation ◽  
Randomized Controlled ◽  
Potential Benefits ◽  
American Society

Purpose To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. Methods An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. Results Nine new observational studies, two systematic reviews, and an updated randomized controlled trial of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. Recommendations Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (nonulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or < 0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of > 1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher-risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors and details of the reference patient populations are included within the guideline. Additional information is available at www.asco.org/melanoma-guidelines and www.asco.org/guidelineswiki .

scholarly journals Melanoma nodal management in Ontario the year after the 2012 American Society of Clinical Oncology and Society of Surgical Oncology guideline

2019 ◽  
Vol 26 (5) ◽  
Author(s):  
S. Latosinsky ◽  
B. Allen ◽  
S. Z. Shariff
Keyword(s):  
Lymph Node ◽  
Clinical Oncology ◽  
Cutaneous Melanoma ◽  
Surgical Oncology ◽  
The United States ◽  
Lymph Node Biopsy ◽  
Administrative Databases ◽  
Guideline Recommendation ◽  
Ontario Cancer Registry ◽  
American Society

Background In 2012 in the United States, the American Society of Clinical Oncology and the Society of Surgical Oncology (asco/sso) published a joint guideline about indications for sentinel lymph node biopsy (slnb) in cutaneous melanoma. The guideline supported completion lymph node dissection (clnd) for all patients with positive sentinel nodes. We examined the rates and predictors of slnb and clnd for melanoma patients in Ontario (population 13.6 million) after publication of that guideline.Methods We used the Ontario Cancer Registry to identify patients diagnosed with cutaneous melanoma in 2013. Patient records were linked to prospectively maintained health administrative databases to obtain details for each patient, including surgical procedures.Results Of the 3298 patients with melanoma identified in Ontario in 2013, 1973 (59.8%) could be analyzed. Most of that group (n = 1227, 62.2%) underwent local excision alone; 746 (37.8%) had a slnb. The slnb was performed in 13.9%, 67.8%, 62.6%, and 47.2% of patients with T1, T2, T3, and T4 primary melanomas respectively. In multivariate analysis, receipt of slnb was positively associated with younger age (<80 years), higher T stage, and a non-head-andneck primary. Of the patients who had a slnb, 136 (18.2%) were found to be node-positive. A clnd was performed in 82 of those patients (60.3%).Conclusions In Ontario, only two thirds of patients with intermediate-thickness melanomas (T2, T3) underwent slnb as recommended by the asco/sso guideline. Use of slnb was less frequent for patients with a head-and-neck primary and higher for younger patients (<80 years). The rate of clnd after a positive slnb was also low relative to the guideline recommendation.

Impact of the Society of Surgical Oncology-American Society for Radiation Oncology Margin Guidelines on Breast-Conserving Surgery and Mastectomy Trends

2019 ◽  
Vol 229 (1) ◽  
pp. 104-114 ◽  
Author(s):  
Olga Kantor ◽  
Catherine Pesce ◽  
Katherine Kopkash ◽  
Ermilo Barrera ◽  
David J. Winchester ◽  
...  
Keyword(s):  
Radiation Oncology ◽  
Surgical Oncology ◽  
Breast Conserving Surgery ◽  
American Society
Sign in / Sign up

Export Citation Format

Share Document