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Robert W. Carlson, D. Craig Allred, Benjamin O. Anderson, Harold J. Burstein, W. Bradford Carter, Stephen B. Edge, John K. Erban, William B. Farrar, Andres Forero, Sharon Hermes Giordano, Lori J. Goldstein, William J. Gradishar, Daniel F. Hayes, Clifford A. Hudis, Britt-Marie Ljung, P. Kelly Marcom, Ingrid A. Mayer, Beryl McCormick, Lori J. Pierce, Elizabeth C. Reed, Mary Lou Smith, George Somlo, Neal S. Topham, John H. Ward, Eric P. Winer, and Antonio C. Wolff

without lymph node dissection. For most patients with more limited disease in whom negative margins are achieved with the initial excision or with reexcision, breast-conserving therapy or total mastectomy are appropriate treatment options. Although

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Robert W. Carlson, D. Craig Allred, Benjamin O. Anderson, Harold J. Burstein, W. Bradford Carter, Stephen B. Edge, John K. Erban, William B. Farrar, Andres Forero, Sharon Hermes Giordano, Lori J. Goldstein, William J. Gradishar, Daniel F. Hayes, Clifford A. Hudis, Britt-Marie Ljung, David A. Mankoff, P. Kelly Marcom, Ingrid A. Mayer, Beryl McCormick, Lori J. Pierce, Elizabeth C. Reed, Jasgit Sachdev, Mary Lou Smith, George Somlo, John H. Ward, Antonio C. Wolff, and Richard Zellars

is optional in the evaluation of women considering breast-conserving therapy. MRI of the breast should be performed using a dedicated breast coil, in consultation with the multidisciplinary treatment team, and by a breast imaging team capable of

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Robert W. Carlson, D. Craig Allred, Benjamin O. Anderson, Harold J. Burstein, W. Bradford Carter, Stephen B. Edge, John K. Erban, William B. Farrar, Lori J. Goldstein, William J. Gradishar, Daniel F. Hayes, Clifford A. Hudis, Mohammad Jahanzeb, Krystyna Kiel, Britt-Marie Ljung, P. Kelly Marcom, Ingrid A. Mayer, Beryl McCormick, Lisle M. Nabell, Lori J. Pierce, Elizabeth C. Reed, Mary Lou Smith, George Somlo, Richard L. Theriault, Neal S. Topham, John H. Ward, Eric P. Winer, and Antonio C. Wolff

on the local recurrence rate in breast conserving therapy: results from the EORTC boost-no-boost trial [abstract] . Int J Radiat Oncol Biol Phys 2007 ; 69 ( 3 Suppl ): S2 – 3 . 63 Fourquet A Campana F Zafrani B . Prognostic factors of

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Stephen B. Edge

outcome advantage over breast-conserving therapy (BCT). One concern with BCT has been a higher rate of local recurrence compared with mastectomy, with initial studies before the routine use of systemic therapy reporting rates of 10% to 20% with BCT. 2

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Presenters: Benjamin O. Anderson and Janice A. Lyons

possibility of omitting RT after breast-conserving therapy in low-risk, hormone receptor–positive patients aged ≥65 years with tumors ≤3 cm. In the PRIME II trial of such patients, radiation provided a local advantage that did not translate into an OS benefit

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William Gradishar and Kilian E. Salerno

The updates to management of early invasive breast cancer in 2016 are minor but have important treatment implications for patients. The NCCN Guidelines Panel for Breast Cancer has added endocrine therapy to its recommendations for the neoadjuvant treatment of patients with ER-rich tumors. For women who are premenopausal at diagnosis, the NCCN Guidelines suggest tamoxifen for 5 years, with or without ovarian suppression, or an aromatase inhibitor for 5 years combined with ovarian suppression or ablation. For HER2-positive patients, neoadjuvant pertuzumab is acceptable, and in advanced estrogen receptor–positive disease, palbociclib can be given with endocrine therapy. Hypofractionation is now the preferred approach for whole-breast irradiation after breast-conserving therapy. Regional nodal irradiation should be strongly considered for women with 1 to 3 positive lymph nodes and is indicated for those with 4 or more positive nodes.

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Puyao C. Li, Zilu Zhang, Angel M. Cronin, and Rinaa S. Punglia

Background: Women with a history of ductal carcinoma in situ (DCIS) are at increased risk for developing a second breast cancer (SBC). A prior meta-analysis of randomized studies of radiotherapy (RT) for DCIS has shown a trend toward increased breast cancer–specific mortality after SBC, but it did not have the power needed to detect a significant difference, due to a limited number of recurrences. This study sought to evaluate the impact of RT for DCIS on mortality after SBC in a larger cohort. Patients and Methods: Using the SEER database, 3,407 patients were identified who received breast-conserving therapy with or without RT for primary DCIS in 2000 through 2013 and subsequently developed a stage I–III invasive SBC within the same time period. Fine-Gray competing risk models were used to study the association between receipt of RT and mortality after SBC. Results: Prior RT was found to be associated with higher rates of breast cancer–specific mortality (hazard ratio [HR], 1.70; 95% CI, 1.18–2.45; P=.005), even after controlling for cancer stage. Interaction analysis suggested that this risk trended higher in patients with ipsilateral versus contralateral SBC (HR, 2.07 vs 1.26; P=.16). Furthermore, compared with patients who developed contralateral SBC, those with ipsilateral SBC were younger (P<.001) and more often lacked estrogen receptor expression (P<.001). Conclusions: Patients who previously received RT for DCIS had higher mortality after developing an invasive SBC than those who did not receive RT. This finding may have implications for initial treatment decisions in the management of DCIS.

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Rodger J. Winn

J . Factors predicting the use of breast-conserving therapy in stage I and II breast cancer . J Clin Oncol 2001 ; 19 : 2254 – 2262 . 3 Nattinger AB Kneusel RYT Hoffmann RG . Relationship between distance from a radiotherapy facility

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Beryl McCormick

iridium implant as sole radiation treatment for operable breast cancer . Eur J Cancer 1996 ; 32A : 608 – 611 . 18 Morrow M White J Moughan J . Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma . J of

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Frederick M. Dirbas

patients with early-stage breast cancer treated with breast conserving therapy . J Surg Oncol 1999 ; 70 : 33 – 40 . 12 King TA Bolton JS Kuske RR . Long-term results of wide-field brachytherapy as the sole method of radiation therapy after