What to Do for Ductal Carcinoma In Situ When Breast-Conserving Surgery Did Not Achieve a Negative Surgical Margin of at Least 2 mm

Clinical Scenario

This protocol addresses ductal carcinoma in situ (DCIS) of the breast in patients who have already undergone a prior surgical intervention but where the defined margin goal was not met, prompting escalation to the next treatment step.

Prior Treatment — Goal Not Reached

The preceding line of treatment was breast-conserving surgery (BCS) — without lymph node surgery — or total mastectomy with sentinel lymph node biopsy (SLNB). The required target for that intervention was a negative histological surgical margin of at least 2 mm. When that margin goal is not achieved, this next-step protocol is indicated.

Next-Step Treatment Approach

Management at this stage involves a form of radiation therapy targeting breast tissue. The specific modality and approach are determined by the clinical context — the complete structured protocol specifies the options and the standard of care for this situation.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/jjco/hyae122

The NCCN Guidelines recommend 'Whole breast radiation therapy (WBRT) [category 1] with or without boost to tumor bed' or 'Accelerated partial breast irradiation (APBI) / partial breast radiation (PBI) [category 2A]' or 'No radiation therapy (RT) [category 2B]'.
HF-WBI is also the standard treatment for patients who have undergone BCS.

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