Grade of recommendation
A
|
a. The target volume of percutaneous adjuvant
radiotherapy should encompass the entire residual breast
and the adjoining chest wall. |
Level of evidence
1a
|
(EBCTCG 2011: Darby S et al. 2011; EBMG 2006; NCCN 2007;
NHMRC2001; NICE 2009; NZGG 2009; SIGN 2005) |
Grade of recommendation
A
|
b. The dose should be approx. 50 Gy in conventional
fractionation (5 × 1.8–2.0 Gy/week). |
Level of evidence
1a
|
(Clarke M et al. 2005; EBCTCG 2011: Darby S et al. 2011;
EBMG 2006; NCCN 2011; NHMRC2001; Peto R 2006; SIGN
2005) |
Grade of recommendation
B
|
c. In older patients without locoregional lymph node
involvement and with tumors < 5 cm who do not require
chemotherapy, hypofractionated regimens can also be used
as an alternative to conventionally fractionated
radiotherapy for percutaneous homogeneous irradiation of
the breast (e.g., 5 × 2.666 Gy per week up to
40 Gy). |
Level of evidence
1a
|
(Goldhirsch A et al. 2011; Harnett A 2010; NCCN 2011;
NICE 2009; Smith BD et al. 2011a; Whelan TJ et al.
2010) |
Grade of recommendation
A
|
d. The application of a local booster dose (boost
irradiation) to the tumor bed reduces the rate of local
recurrence in the breast without conferring an advantage
in terms of survival.Boost irradiation is
generally indicated. The recommended boost dose is
(10–)16 Gy in conventional fractionation
(5 × 1.8–2.0 Gy/week). |
Level of evidence
1a
|
(Antonini N et al. 2007; Bartelink H et al. 2007; Jones
HA et al. 2009; Livi L et al. 2009; Poortmans P 2007;
Poortmans PM et al. 2008; Poortmans PM et al. 2009;
Romestaing P et al. 1997; Romestaing P et al. 2009;
Sautter-Bihl ML et al. 2007; SIGN 2005) |
Grade of recommendation
C
|
e. In postmenopausal patients with a very low risk of
local recurrence (in particular, age > 60 years,
small tumors and favorable prognostic factors), the
absolute advantage conferred by boost irradiation is
small. In this subgroup, the administration of boost
irradiation may be omitted if necessary. |
Level of evidence
2a
|
(EBCTCG 2011: Darby S et al. 2011; NZGG 2009) |