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Guideline Writers Reject Partial Breast Irradiation for Breast Cancer: Presented at NCCN

By Ed Susman

HOLLYWOOD, FL -- March 13, 2006 -- New guidelines for breast cancer treatment relegate the use of partial breast irradiation -- a procedure in which intensive, short-term radiation is concentrated in the tumor bed -- to an experimental status.

"Partial breast irradiation should only be performed as part of a high quality prospective clinical trial," said Benjamin Anderson, MD, Director, Breast Health Center, University of Washington, Fred Hutchinson Cancer Research Center, Washington, United States.

"Whole breast irradiation with boost (by photons, brachytherapy of electron beam) remains the standard of care," Dr. Anderson said during a presentation here on March 10^th at the 11th annual conference of the National Comprehensive Cancer Network (NCCN).

Dr. Anderson presenting part of the breast cancer treatment guidelines for the 19 member institutions that make up the NCCN and hundreds of other hospitals around the world.

"We understand that the partial irradiation procedure is exciting and appears to have some benefit," Dr. Anderson said. "However, the panel did not feel that the evidence is sufficiently mature to include it as an option in the recommendations."

The NCCN guidelines, since they were first promulgated in 1995, have always advocated well-designed clinical trials to provide the first-line Level 1 evidence for inclusion in the guidelines.

At the NCCN conference, Dr. Anderson and his colleague Robert Carlson, MD, Professor of Medicine, Stanford University, California, discussed several new additions to the breast cancer guidelines. The guidelines for breast cancer have been updated in each of the 11 years that the NCCN has been producing the treatment algorithms, attesting to continuing research into treatment of breast cancer.

In another change, Dr. Anderson said that the guideline writer did some wordsmithing in response to input from other doctors. He explained that surgery for breast conservation or lumpectomy involves "widespread disease" when that lesion cannot be removed through a single incision if that incision cannot achieve adequate negative margins and still achieve an acceptable cosmetic outcome.

"Widespread disease contraindicates breast conservation, he said.


[Presentation title: Update: Breast Cancer Guidelines.]

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