NCCN VERSION 2 2015

NCCN Guidelines Version 2.2015 Invasive Breast Cancer

NCCN Guidelines Index Breast Cancer Table of Contents Discussion

SPECIAL CONSIDERATIONS TO BREAST-CONSERVING THERAPY REQUIRING RADIATION THERAPY Contraindications for breast-conserving therapy requiring radiation therapy include:

Absolute: • Radiation therapy during pregnancy • Diffuse suspicious or malignant-appearing microcalcifications • Widespread disease that cannot be incorporated by local excision through a single incision that achieves negative margins with a satisfactory cosmetic result • Positive pathologic margin 1 Relative: • Prior radiation therapy to the chest wall or breast; knowledge of doses and volumes prescribed is essential. • Active connective tissue disease involving the skin (especially scleroderma and lupus) • Tumors >5 cm (category 2B) • Diffusely positive pathologic margins 1 • Women with a known or suspected genetic predisposition to breast cancer: May have an increased risk of ipsilateral breast recurrence or contralateral breast cancer with breast-conserving therapy Prophylactic bilateral mastectomy for risk reduction may be considered. (See NCCN Guidelines for Breast Cancer Risk Reduction) .

1 See Margin Status in Infiltrating Carcinoma (BINV-F) .

Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.

BINV-G

Version2.2015, 03/11/2015© National Comprehensive Cancer Network, Inc. 2015,All rights reserved.The NCCN Guidelines ® and this illustration may not be reproduced in any form without the express written permission of NCCN ® .