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NCCN Guidelines Index
Breast Cancer Table of Contents
Discussion
Version2.2015, 03/11/2015© National Comprehensive Cancer Network, Inc. 2015,All rights reserved.The NCCN Guidelines
®
and this illustration may not be reproduced in any form without the express written permission of NCCN
®
.
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
BINV-3
NCCN Guidelines Version 2.2015
Invasive Breast Cancer
LOCOREGIONAL TREATMENT OF CLINICAL STAGE I, IIA, OR IIB DISEASE OR T3, N1, M0
j
See Surgical Axillary Staging (BINV-D)
.
k
See Axillary Lymph Node Staging (BINV-E) and Margin Status in Infiltrating Carcinoma (BINV-F)
.
n
See Principles of Breast Reconstruction Following Surgery (BINV-H)
.
o
Consider imaging for systemic staging, including diagnostic CT or MRI, bone scan, and optional FDG PET/CT (category 2B) (
See BINV-1
).
p
See Principles of Radiation Therapy (BINV-I)
.
q
Radiation therapy should be given to the internal mammary lymph nodes that are clinically or pathologically positive; otherwise the treatment to the internal mammary
nodes is at the discretion of the treating radiation oncologist. CT treatment planning should be utilized in all cases where radiation therapy is delivered to the internal
mammary lymph nodes.
t
Postmastectomy radiation therapy may be considered for patients with multiple high-risk recurrence factors.
Total mastectomy with
surgical axillary
staging
j,k
(category 1)
± reconstruction
n
≥4 positive
axillary nodes
o
1–3 positive
axillary nodes
Negative axillary nodes
and tumor >5 cm
or
margins positive
Negative axillary nodes and
tumor ≤5 cm and negative
margins but <1 mm
Negative axillary nodes
and tumor ≤5 cm and
margins ≥1 mm
Postchemotherapy radiation therapy to chest wall
(category 1) + infraclavicular and supraclavicular
areas.
p
Strongly consider radiation therapy
p,q
to
internal mammary nodes (category 2B).
Strongly consider postchemotherapy radiation therapy
to chest wall + infraclavicular and supraclavicular areas;
p
if radiation therapy is given, strongly consider internal
mammary node radiation therapy
p,q
(category 2B).
Consider postchemotherapy radiation therapy to chest
wall ± infraclavicular and supraclavicular nodes. Strongly
consider radiation therapy
p
to internal mammary nodes
(category 2B).
Consider postchemotherapy radiation therapy
p
to chest wall.
No radiation therapy
t
See
BINV-4