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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?
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Radiation Oncology · Harold C Simmons Comprehensive Cancer Center/UT Southwestern
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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.

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Radiation Oncology · Allegheny Health Network, Pittsburgh
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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.

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Radiation Oncology · Rutgers Robert Wood Johnson Medical School
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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...

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Radiation Oncology · Varian Medical Systems/Allegheny health network
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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.

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