American College of Radiology appropriateness criteria on conservative surgery and radiation: stages I and II breast carcinoma.
BACKGROUND
During the past 2 decades, breast conservation therapy (BCT) has become firmly established as a standard therapeutic approach for eligible women with early-stage breast cancer. Breast radiation after conservative surgery is an integral component of BCT, resulting in comparable local control and equivalent survival to mastectomy. Successful breast conservation relies on understanding key elements for patient selection, evaluation, treatment contraindications, radiation therapy methods, and integration with systemic therapy.


METHODS
The Appropriateness Criteria Committee of the American College of Radiology convened an expert panel to examine BCT for early-stage breast cancer. By using a modified Delphi technique to generate consensus, the expert panel responded to questionnaires on 9 clinical cases that address various key elements of breast conservation. A literature review on BCT led to the generation of an evidence table to support the consensus and overview.


RESULTS
Consensus for appropriateness criteria for BCT was produced for various clinical scenarios commonly encountered in practice. These topics include radiation oncology management issues related to young patient age, sentinel node biopsy, elderly patients, other histology, positive margins, extensive intraductal component, node-positive breast cancer, genetic breast cancer, partial breast irradiation, and systemic therapy. Radiation methods for BCT are reviewed.


CONCLUSIONS
The Breast Cancer Panel has generated a consensus of up-to-date guidelines for the appropriate use of radiation for BCT by using a modified Delphi process for the American College of Radiology Appropriateness Criteria.
Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226-4801 , USA. jwhite@mcw.edu
Julia R
JR
White
Francine E
FE
Halberg
Rachel
R
Rabinovitch
Sheryl
S
Green
Bruce G
BG
Haffty
Lawrence J
LJ
Solin
Eric A
EA
Strom
Marie E
ME
Taylor
Stephen B
SB
Edge
D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D015412:Mastectomy, Segmental / Q000592:standards*; D018579:Patient Selection; D011871:Radiology / Q000592:standards*; D011878:Radiotherapy / Q000592:standards*; D012955:Societies, Medical; D014481:United States