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ACR Appropriateness Criteria® Conservative surgery and Radiation – Stage I and II Breast Carcinoma

Expert Panel on Radiation Oncology: Breast


Address correspondence and reprint requests to: Jennifer R. Bellon, MD, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA, or e-mail: American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria® through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply society endorsement of the final document. This article is a revised version of the American College of Radiology Appropriateness Criteria Conservative Surgery and Radiation – Stage I and II Breast Carcinoma , excerpts of which are reprinted here with permission. Practitioners are encouraged to refer to the complete version at


Abstract:  Breast conservation is a safe and effective alternative to mastectomy for the majority of women with early-stage breast cancer. Adjuvant radiation therapy lowers the risk of recurrence within the breast and also confers a survival benefit. Although acute side effects of radiation therapy are generally well tolerated; efforts are ongoing to minimize the long-term side effects of radiation, most prominently atherosclerotic heart disease. Efforts to minimize radiation therapy are also underway. They include omitting treatment altogether in the elderly and using accelerated, hypofractionated whole-breast irradiation, and accelerated partial-breast irradiation. Several randomized studies are ongoing to determine the efficacy, safety, and appropriate patients for these shorter treatments.