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Recommendation
Partial breast irradiation – Considerations
In patients with breast cancer (excluding lobular type) who have undergone breast-conserving surgery with clear surgical margins and who have a very low risk of local recurrence, partial breast irradiation can be considered if patients are suitable and willing to take adjuvant endocrine therapy for five years.
Consider omitting radiotherapy for women who: have had breast-conserving surgery for invasive breast cancer with clear margins and; have a very low absolute risk of local recurrence (defined as women aged 65 and over with tumours that are T1N0, ER-positive, HER2-negative and grade 1 to 2) and; are willing to take adjuvant endocrine therapy for a minimum of 5 years.)
APBI is an acceptable treatment option in patients with a low risk for local recurrence (Level of evidence – III)
Insufficient evidence for efficacy or benefit does not outweigh the risk or the disadvantages (adverse events, costs, etc.), optional
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How this guidance was developed
This recommendation was adapted from the NICE 2018 guidelines (UK). The source recommendation was based on a systematic review of the evidence conducted to September 2017 and used wording (‘Consider’) indicative of a conditional recommendation (using GRADE methods) by the source guideline authors. The source recommendation was adapted by including a link to a validated predictive tool rather than providing a definition of 'very low risk of local recurrence' within the recommendation. The recommendation was also made gender neutral, and less directive by replacing "consider" with "can be considered".
This recommendation is supported by a more recent recommendation in ESMO 2019 (Europe) clinical practice guidelines, graded ‘C’ (using ESMO methods adapted from the Infectious Diseases Society of America-United States Public Health Service Grading System).
Partial breast irradiation – Considerations
Recommendation
In patients with breast cancer (excluding lobular type) who have undergone breast-conserving surgery with clear surgical margins and who have a very low risk of local recurrence, partial breast irradiation can be considered if patients are suitable and willing to take adjuvant endocrine therapy for five years.
Principles in action
Patient-centred care
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Communication
This recommendation was adapted from the NICE 2018 guidelines (UK). The source recommendation was based on a systematic review of the evidence conducted to September 2017 and used wording (‘Consider’) indicative of a conditional recommendation (using GRADE methods) by the source guideline authors. The source recommendation was adapted by including a link to a validated predictive tool rather than providing a definition of 'very low risk of local recurrence' within the recommendation. The recommendation was also made gender neutral, and less directive by replacing "consider" with "can be considered".
This recommendation is supported by a more recent recommendation in ESMO 2019 (Europe) clinical practice guidelines, graded ‘C’ (using ESMO methods adapted from the Infectious Diseases Society of America-United States Public Health Service Grading System).