Radiation Therapy For The Whole Breast

For women with invasive breast cancer receiving WBI with or without inclusion of the low axilla, the preferred dose-fractionation scheme is HF-WBI to a dose of 4000 cGy in 15 fractions or 4250 cGy in 16 fractions. (Strong, High)

A tumor bed boost is recommended for patients with invasive breast cancer who meet any of the following criteria: age ≤50 years with any grade, age 51 to 70 years with high grade, or a positive margin. (Strong, Moderate)

Omitting a tumor bed boost is suggested in patients with invasive breast cancer who meet the following criteria: age >70 years with hormone receptor-positive tumors of low or intermediate grade resected with widely negative (≥2 mm) margins. (Conditional, Moderate)

For patients with invasive breast cancer not meeting criteria articulated in KQ2A or KQ2B, individualized decision-making is suggested because the decision in these cases is highly sensitive to patient preferences and values regarding the modest expected disease control benefit and the modest increase in treatment-related burden and toxicity associated with boost radiation therapy. (Conditional, Moderate)