Guidelines on dose escalation and de-escalation for early stage breast cancer

This item reviewed treatment guidelines that have been recommended for early stage breast cancer. 

The St. Gallen International Breast Cancer Conference gathers leading experts in breast cancer research and makes treatment guidelines. The 2017 conference has added to the consensus on dose escalation or de-escalation of radiation therapy for early stage breast cancers. 

These guidelines were made after assessment of treatments in terms of side-effects, intensity and duration. 

The panel made recommendations to decrease side-effects that can occur with surgery. Chemotherapy is often used prior to surgery to shrink a tumor. The panel concluded that if the tumor shrinks, it is not necessary to surgically remove the entire area of the original tumor. It also recommended that 2 mm surgical margins can be used in the case of very early breast cancers like DCIS (ductal carcinoma in situ). It also recommended the use of chemotherapy or treatments such as trastuzumab (Herceptin) for HER-2 positive, hormone receptor negative breast cancers that are stage II or III. 

It was recommended that radiation therapy dose is escalated, or increased, for high risk patients with lymph node involvement. It is also recommended that a boost dose (an additional radiation dose to the original site of the tumor) not be done for lower risk patients. Lower risk patients could include those over 60, with low grade tumor features who will be receiving adjuvant treatment. 

Chemotherapy after surgery is recommended for all types of breast cancer, except patients with specific genetic results who also have estrogen receptor positive breast cancer.

Hormone therapy (such as tamoxifen) doses should increase for high risk pre-menopausal women in order to suppress the hormones that are produced by the ovaries. The duration of treatment should increase for post-menopausal women.

Bisphosphonates (such as zoledronic acid) are also recommended for postmenopausal women to prevent breast cancer recurrence. Bisphosphonates are medications that are used in osteoporosis and can strengthen bones. 

This study reviewed the updated St. Gallen recommendations for early breast cancer treatment.

These guidelines are general. Every patient will not fall into one of these categories and doctors will make decisions based on a patient's specific circumstance. 

Discuss this article with your doctor, if applicable.