Purpose

To develop a summary of recommendations regarding locoregional management of patients with breast cancer and germline mutations in breast cancer susceptibility genes based on the American Society of Clinical Oncology/American Society for Radiation Oncology/Society of Surgical Oncology Guideline on Management of Hereditary Breast Cancer.

Methods

The American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology convened an expert panel to develop recommendations based on a systematic review of the literature and a formal consensus process. A total of 58 articles met the eligibility criteria and formed the evidentiary basis for the locoregional therapy recommendations. Additionally, 6 randomized controlled trials of systemic therapy also met eligibility criteria.

Results

A joint evidence-based guideline was developed by a multidisciplinary panel, which has been separately published. From this guideline, the radiation-oncologist authors of the panel extracted pertinent surgical and radiation-specific recommendations of findings that are hereby presented.

Conclusions

Patients with newly diagnosed breast cancer and BRCA1/2 mutations may be considered for breast conserving therapy (BCT), expecting similar rates of local control of the index cancer as noncarriers. The significant risk of contralateral breast cancer in these women (especially younger women), coupled with the higher risk of new cancers in the ipsilateral breast, warrant discussion of bilateral mastectomy. For women with mutations in BRCA1/2 or moderate-penetrance genes who are eligible for mastectomy, nipple-sparing mastectomy is a reasonable approach. There is no evidence of increased toxicity or contralateral breast cancer events from radiation exposure in BRCA1/2 carriers. Patients with mutations in moderate-risk genes should be offered BCT as one choice after appropriate counseling. Radiation therapy should not be withheld in ATM carriers if BCT is planned. For patients with germline TP53 mutations, mastectomy is advised and radiation therapy is contraindicated except for those with a significant risk of locoregional recurrence.

中文翻译：

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《 ASCO-ASTRO-SSO遗传性乳腺癌管理指南》的ASTRO放射治疗摘要。

目的

根据美国临床肿瘤学会/美国放射肿瘤学会/外科肿瘤学会遗传性乳腺癌治疗指南，对乳腺癌患者局部治疗和乳腺癌易感基因种系突变的建议进行总结。

方法

美国临床肿瘤学会，美国放射肿瘤学会和外科肿瘤学会召集了一个专家小组，根据对文献的系统评价和正式的共识程序来制定建议。共有58篇文章符合资格标准，并为局部治疗建议提供了证据基础。此外，有6项系统治疗的随机对照试验也符合入选标准。

结果

一个多学科小组制定了联合的基于证据的指南，该指南已单独出版。该小组的放射肿瘤学家从该指南中提取了相关的手术和特定于放射线的发现建议，特此介绍。

结论

具有新诊断的乳腺癌和BRCA1 / 2突变的患者可以考虑进行保乳治疗（BCT），期望对局部指数癌症的控制率与非携带者相似。这些女性（尤其是年轻女性）患对侧乳癌的风险较高，同侧乳腺癌的风险也较高，因此有必要进行双侧乳房切除术的讨论。对于有资格进行乳房切除术的BRCA1 / 2或中度穿透基因突变的女性，保留乳头乳房切除术是一种合理的方法。没有证据表明BRCA1 / 2的辐射暴露会增加毒性或对侧乳腺癌事件运营商。经过适当咨询后，应将中度高风险基因突变的患者作为BCT的一种选择。如果计划进行BCT，则不应在ATM载体中停止放疗。对于具有种系TP53突变的患者，建议行乳房切除术，并且放疗是禁忌的，除非那些局部复发的风险很高。