NCCN VERSION 2 2015

NCCN Guidelines Version 2.2015 Invasive Breast Cancer LOCOREGIONAL TREATMENT OF CLINICAL STAGE I, IIA, OR IIB DISEASE OR T3, N1, M0

NCCN Guidelines Index Breast Cancer Table of Contents Discussion

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).

≥4 positive axillary nodes o

1–3 positive axillary nodes

Total mastectomy with surgical axillary staging j,k (category 1) ± reconstruction n

Negative axillary nodes and tumor >5 cm or margins positive Negative axillary nodes and tumor ≤5 cm and negative margins but <1 mm

See BINV-4

Consider postchemotherapy radiation therapy p to chest wall.

Negative axillary nodes and tumor ≤5 cm and margins ≥1 mm

No radiation therapy t

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.

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

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 ® .