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

We use 50Gy/25fx and 10Gy/5fx boost for DCIS pts with close margins.

Post -lumpectomy mammograms should be obtained to rule out residual calcifications.

I offer these patients either hypofractionated WBI (40/15, FAST, FAST-Forward). Consider boost based on margin and other factors.

Do consider these patients (DCIS, ER+, 0-2 mm margin) for partial breast as well.

Although this specific situation was not addressed in the recent ASTRO whole breast guideline published in PRO, in a DCIS patient with a negative margin and no residual calcifications, even if the margin was close, I would do a conventional boost of 1000 in 4 or 5 fractions.

In a younger patient, hi...

We routinely treat with hypofractionation followed by a boost. This is equivalent to conventional fraction dose and there is no data that dose escalation improves outcome.

The pts get a mammogram prior to rule out residual calcs.