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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-13
NCCN Guidelines Version 2.2015
Invasive Breast Cancer
j
See Surgical Axillary Staging (BINV-D)
.
p
See Principles of Radiation Therapy (BINV-I)
.
x
Chemotherapy and endocrine therapy used as adjuvant therapy should be given sequentially with endocrine therapy following chemotherapy. Available data suggest
that sequential or concurrent endocrine therapy with radiation therapy is acceptable.
mm
Axillary staging following preoperative systemic therapy may include sentinel node biopsy or level I/II dissection. Level I/II dissection should be done for patients who
were proven node-positive prior to neoadjuvant therapy (category 2B).
Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective,
multicentre cohort study. Lancet Oncol 2013;14(7):609-18. Epub 2013/05/21.
Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG
Z1071 (Alliance) clinical trial. JAMA 2013;310(14):1455-61. Epub 2013/10/09.
Preoperative Systemic Therapy Guideline
LOCAL TREATMENT
ADJUVANT TREATMENT
Mastectomy and surgical axillary
staging
j,mm
± reconstruction.
If sentinel lymph node biopsy
performed prechemotherapy and
negative findings, may omit axillary
lymph node staging
Lumpectomy with surgical axillary
staging.
j,mm
If sentinel lymph node
biopsy performed prechemotherapy
and negative findings, may omit
axillary lymph node staging
See BINV-11
• Complete planned chemotherapy regimen course if not completed
preoperatively plus endocrine treatment if ER-positive and/or PR-positive
(sequential chemotherapy followed by endocrine therapy).
• Adjuvant radiation therapy
p
post-mastectomy is based on
prechemotherapy tumor characteristics as per
BINV-3
and
Endocrine therapy if ER-positive and/or PR-positive
x
(category 1)
• Complete up to one year of trastuzumab therapy if HER2-positive
(category 1). May be administered concurrently with radiation therapy
p
and with endocrine therapy if indicated.
See Adjuvant Endocrine Therapy (BINV-J)
• Complete planned chemotherapy regimen course if not completed
preoperatively plus endocrine treatment if ER-positive and/or PR-positive
(sequential chemotherapy followed by endocrine therapy).
• Adjuvant radiation therapy
p
post-lumpectomy based on prechemotherapy
tumor characteristics as per
BINV-2
and
Endocrine therapy if ER-positive and/or PR-positive
x
(category 1)
• Complete up to one year of trastuzumab therapy if HER2-positive
(category 1). May be administered concurrently with radiation therapy
p
and with endocrine therapy if indicated.
See Adjuvant Endocrine Therapy (BINV-J)
See
Surveillance/
Follow-up
(BINV-16)