title: 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.
abstract: OBJECTIVE
  To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy.
  
  
  METHODS
  A multidisciplinary consensus panel used a meta-analysis of margin width and 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 2-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 than no ink on tumor 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut.
authors: Meena S
authors: MS
authors: Moran
authors: Department of Pathology, Harvard Medical School, Boston, Massachusetts.
authors: Stuart J
authors: SJ
authors: Schnitt
authors: Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California.
authors: Armando E
authors: AE
authors: Giuliano
authors: Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts.
authors: Jay R
authors: JR
authors: Harris
authors: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Seema A
authors: SA
authors: Khan
authors: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
authors: Janet
authors: J
authors: Horton
authors: Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, Arkansas.
authors: Suzanne
authors: S
authors: Klimberg
authors: Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Mariana
authors: M
authors: Chavez-MacGregor
authors: Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors: Gary
authors: G
authors: Freedman
authors: School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors: Nehmat
authors: N
authors: Houssami
authors: Advocate in Science, Susan G. Komen, Wichita, Kansas.
authors: Peggy L
authors: PL
authors: Johnson
authors: Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: morrowm@mskcc.org.
authors: Monica
authors: M
authors: Morrow
mesh_terms: D000367:Age Factors; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods / Q000592:standards; D032921:Consensus; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000592:standards*; D008495:Medical Oncology / Q000592:standards*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016609:Neoplasms, Second Primary / Q000517:prevention & control; D018787:Radiation Oncology / Q000592:standards*; D018714:Radiotherapy, Adjuvant / Q000379:methods / Q000592:standards; D012189:Retrospective Studies; D012955:Societies, Medical; D014481:United States
chemical_list: D000970:Antineoplastic Agents