What total dose do you use for a close and positive breast cancer margin that cannot be re-excised?

Based on consensus guidelines, there is no such thing as a close margin as HR for recurrence did not change based on margin width. That was the reason for group to conclude that no tumor at inked margin is a negative margin (except for pure DCIS or those who had neoadjuvant chemo).

If we give a boost...

According to the most recent 2018 ASTRO whole breast fractionation guidelines, in the presence of strong risk factor(s) for local recurrence, such as the single risk factor of positive margins or a combination of risk factors such as young age and close margins, a higher radiation boost dose of 1400...

Piggybacking on some of the above comments on positive margins and surgery, I do wish every institution used intraoperative pathology for all breast cancer cases, similar to the Mayo Clinic. An anecdotal case to share is a patient who sought a second opinion at the Mayo Clinic and underwent a third ...