NCCN VERSION 2 2015

NCCN Guidelines Index

Breast Cancer Table of Contents

Discussion

UPDATES-3

NCCN Guidelines Version 2.2015

Breast Cancer Updates

Updates in Version 1.2015 of the NCCN Guidelines for Breast Cancer from Version 3.2014 include:

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BINV-F (continued)

• Second paragraph, added the following statement "A boost to the tumor

bed is recommended in patients at higher risk (age <50 or high-grade

disease, or patients with focally positive margins). This can be achieved

with brachytherapy or electron beam or photon fields. Typical doses are

10–16 Gy at 2 Gy/fx."

BINV-H

(2 of 2)

• First bullet, added the following statement "Nipple margin assessment is

mandatory, and the nipple margin should be clearly designated."

BINV-I

• Whole Breast Radiation, modified the statement: "The breast should

receive a dose of 45–50 Gy in 1.8-2 Gy per 23–25 fractions, or 40–42.5 Gy

in 15–16 fractions (short course is preferred)."

• Regional Nodal Radiation, replaced "If internal mammary lymph nodes

are clinically or pathologically positive, radiation therapy should be given

to the internal mammary nodes. Otherwise the treatment to the internal

mammary nodes is at the discretion of the treating radiation oncologist"

with "Based on the modern post mastectomy radiation randomized

trials and other recent studies, consider including the internal mammary

lymph nodes when delivering regional nodal irradiation."

BINV-J

• Added a new footnote for premenopausal at diagnosis stating,

"Aromatase inhibitor for 5 y + ovarian suppression may be considered as

an alternative option based on SOFT and TEXT clinical trial outcomes."

Pagani O, Regan M, Walley B, et al. Adjuvant Exemestane with Ovarian

Suppression in Premenopausal Breast Cancer. N Engl J Med 2014;

371:107-118. July 10, 2014DOI: 10.1056/NEJMoa1404037.

BINV-K

• Other regimens for HER2-negative disease, added "AC (doxorubicin/

cyclophosphamide) every 3 weeks

(category 2B)."

• Other regimens for HER2-positive disease, added "Docetaxel +

cyclophosphamide + trastuzumab."

• Updated reference list.

BINV-19

• Added footnote "yy" to the following nodes:

ER-and/or PR positive; HER2 positive

Prior endocrine therapy within 1 y – Postmenopausal

BINV-B

• Clinical Indications and Applications, removed the following bullet: "May

be useful to detect additional disease in women with mammographically

dense breast, but available data do not show differential detection rates

by any subset by breast pattern (breast density) or disease type (eg, DCIS,

invasive ductal cancer, invasive lobular cancer)."

BINV-C

• Deleted "No therapy has been shown to preserve fertility in patients

receiving chemotherapy."

• Added "Randomized trials have shown that ovarian suppression with

GnRH agonist therapy administered during adjuvant chemotherapy

in premenopausal women with ER-negative tumors may preserve

ovarian function and diminish the lkelihood of chemotherapy-induced

amenorrhea."

• Added "Smaller historical experiences in patients with ER-positive disease

have reported conflicting results with regards to the protective effect of

GNRH agonist therapy on fertility."

BINV-D

• Sentinel node positive: removed "Axillary dissection level I/II" as an

option.

• Added footnote "4" stating: "For patients with clinically negative axillae

who are undergoing mastectomy and for whom radiation therapy is

planned, axillary radiation may replace axillary dissection level I/II for

regional control of disease."

BINV-F

• First paragraph, added the following statement "The NCCN Panel accepts

the definition of a negative margin as "No ink on the tumor," from the 2014

Society of Surgical Oncology-American Society for Radiation Oncology

Consensus Guidelines on Margins."

• Added Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton

J, et al. Society of Surgical Oncology-American Society for Radiation

Oncology consensus guideline on margins for breast-conserving surgery

with whole-breast irradiation in stages I and II invasive breast cancer. J

Clin Oncol. 2014 May 10;32(14):1507-15

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