Who Should Receive a Radiation Boost to the Tumor Bed after Breast Conserving Surgery?

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Updated 2018 American Society for Radiation Oncology (ASTRO) guidelines:
    • State that patients 50 and younger, and 51 to 70 years of age with high-grade tumors or positive margins:
      • Should receive a tumor bed boost
    • A boost may be omitted for women:
      • Older than 70 with hormone receptor positive and low- or intermediate-grade disease with widely negative margins (> 2 mm)
    • If the patient does not meet either of those criteria, individualized decision making is recommended
    • For ductal carcinoma in situ (DCIS):
      • Tumor bed boost may be used for women:
        • 50 years of age and younger
        • Close (less than 2 mm) or positive margins
        • High-grade disease
      • It may be omitted for patients:
        • Older than 50 with screening detected
        • Total size less than 2.5 cm
        • Low to intermediate nuclear grade
        • Widely negative margins:
          • Greater than 3 mm
      • Long-term 20-year follow-up of a phase 3 trial of boost vs. no boost:
        • Reported a benefit in all groups with the largest absolute risk reduction in younger patients
  • References
    • Smith BD, Bellon JR, Blitzblau R, et al. Radiation therapy for the whole breast: executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018;8(3):145-152.
    • Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lanc Oncol. 2015;16(1):47-56.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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