What technique, total dose, and fractionation do you use for DCIS following lumpectomy with <2 mm negative margins which are not re-excised?  

The recently published SSO/ASTRO/ASCO consensus guideline on DCIS states that "a 2 mm margin minimizes the risk of IBTR compared with smaller negative margins" but "negative margins less than 2 mm alone" are not an indication for re-excision. Furthermore, it says "there is no evidence that margin width, in isolation, should determine radiation delivery technique, fractionation of WBRT, or use/dose of a boost." Thus, there is no guidance on the optimal management for DCIS patients with <2 mm negative margins who are not re-excised. How do you manage these patients? Is hypofractionation acceptable? Is boost indicated, and if so, to what dose?



Answer from: Radiation Oncologist at Community Practice

Answer from: Radiation Oncologist at Academic Institution
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Radiation Oncologist at Mallory Radiotherapy, PLLC
What is the rationale for offering APBI for DCIS w...
Radiation Oncologist at Cleveland Clinic
Current margin guidelines counsel that in patients...
Radiation Oncologist at Mallory Radiotherapy, PLLC
Thank you for clarifying, Dr. @Chirag S. Shah. I r...
Radiation Oncologist at Varian Medical Systems/Allegheny health network
B39 was allowed all negative margins (irrespective...
Radiation Oncologist at Cleveland Clinic
Agree with Dr. @Sushil Beriwal. Not sure about the...
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Answer from: Radiation Oncologist at Academic Institution

Answer from: Radiation Oncologist at Community Practice
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Radiation Oncologist at CCare
Do you boost more than 10Gy for close margin?
Radiation Oncologist at Varian Medical Systems/Allegheny health network
Not routinely.
Radiation Oncologist at Froedtert and the Medical College of Wisconsin Froedtert Hospital
@Sushil Beriwal what dose have you used in the cas...
Radiation Oncologist at Varian Medical Systems/Allegheny health network
I would get a mammogram to rule out any residual c...
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