Kilian E. Salerno, MD
Updated guidelines for the management of invasive breast cancer, issued by the National Comprehensive Cancer Network (NCCN), define indications for radiation therapy, the use of biomarkers and multigene assays in clinical decision making, and new concepts in endocrine therapy in early-stage and advanced-stage estrogen receptor (ER)-positive breast cancer.
An overview of the updates added to version 1.2017 of the NCCN guidelines1 was presented at the 2017 NCCN Annual Conference.
Suitability Requirements for Radiation Targets
“When we’re treating, we really want to define what the target is,” said Kilian E. Salerno, MD, associate professor of oncology and director of breast radiation and soft tissue/melanoma radiation, Roswell Park Cancer Institute, and clinical associate professor, Department of Radiation Oncology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo. Treatment targets for radiation in breast cancer include wholebreast irradiation, partial-breast irradiation (PBI), radiation to the chest wall, and regional nodal irradiation (RNI).
In general, RNI is recommended for patients with ≥4 positive nodes or locally advanced disease, should be strongly considered for patients with 1 to 3 positive nodes, and may be considered for node-negative patients at high risk of recurrence (Table).
Table. Locoregional Treatment by Surgical Axillary Staging After Mastectomy
Incorporating Multigene Assays
The latest version of the NCCN breast cancer guidelines incorporate the use of genomic expression profiling to assist in adjuvant treatment decision making in women with hormone receptor (HR)-positive, HER2-negative breast cancer. Lee S. Schwartzberg, MD, povided a summary of the state of biomarkers and multigene assays in breast cancer.
... to read the full story