Citations 2
Breast Cancer, Version 4.2026, NCCN Clinical Practice Guidelines In Oncology
Gradishar, W J, Moran, Meena S. , Abraham, Jame , Abramson, Vandana, Aft, Rebecca, Agnese, Doreen, Allison, Kimberly H., Anderson, Bethany, Bailey, Janet, Burstein, Harold J. , Chen, Nan , Chew, Helen, Dang, Chau, Giordano, Sharon H., Goetz, Matthew P., Jankowitz, Rachel C., Javid, Sara H., Leitch, A. Marilyn, LYONS, JANICE, McCloskey, Susie, McShane, Melissa , Patel, Sameer A. , Rosenberger, Laura H., Santa‐Maria, Cesar A. , Schneider, Bryan P., Smith, Mary Lou , Soliman, Hatem, Speers, Corey, Telli, Melinda L. , Wei, Mei , Wisinski, Kari B., Yellala, Amulya, Schonfeld, Ryan, Telli, Melinda L , Gradishar, William John, Abramson, Vandana G. , Agnese, Doreen Marie , Allison, Kimberly H. , Bailey, Janet E., Chew, Helen K. , Elias, Anthony , Giordano, Sharon H. , Goetz, Matthew P. , Jankowitz, Rachel C. , Javid, Sara H. , Leitch, A. Marilyn , Rosenberger, Laura H. , Rugo, Hope S. , Santa-Maria, Cesar Augusto , Schneider, Bryan P. , Soliman, Hatem, Speers, Corey , Wisinski, Kari B. , Yeung, Kay T. , Young, Jessica S. , Kumar, Rashmi
Journal of the National Comprehensive Cancer Network | July 9, 2026 | Volume: 24 | Issue: 7 | Pages: No page available
The NCCN Clinical Practice Guidelines for Breast Cancer include recommendations for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget’s disease, Phyllodes tumor, inflammatory breast cancer, and management of breast cancer during pregnancy. The panel convenes annually to update recommendations based on a review of recently published clinical trials. This selection from the NCCN Guidelines for Breast Cancer focuses on the recommendations for the management of recurrent or stage IV (M1) metastatic breast cancer. It summarizes the treatment strategies stratified by tumor biology, including hormone receptor status and HER2 expression, as well as clinical factors such as prior therapy and disease-free interval. Throughout all treatment lines, supportive care, quality of life preservation, toxicity minimization, and clinical trial participation are emphasized as integral components of patient care.
Concurrent Versus Sequential Radiation Dose Escalation to the Surgical Cavity for Conservative Treatment of High-Risk Early Breast Cancer: NRG/RTOG 1005 Phase III Trial
Vicini, Frank A. , Winter, Kathryn, Freedman, Gary M., Arthur, Douglas W., Rosenstein, Barry S. , Li, X. Allen , Halyard, Michele Y. , Woodward, Wendy A. , LYONS, JANICE, Tomberlin, Janice K., Seaward, Samantha A. , Cheston, Sally B. , Hoover, A. , Perera, Francisco E. , Poppe, Matthew M. , Petersen, Ivy A., Jhawar, S., Moughan, Jennifer, Movsas, B, White, Julia , Li, X. Allen , Woodward, Wendy A , Bleicher, Richard J , Taghian, Alphonse , Lyons, Janice , Seaward, Samantha A , Hoover, Andrew C , Anderson, Bethany M , Perera, Francisco E , Jhawar, Sachin R , Hijal, Tarek , Movsas, Benjamin , White, Julia R , Freedman, Gary M. , Bentzen, Søren M. , Anderson, Bethany M. , Perera, Francisco E, Petersen, Ivy A. , Jhawar, Sachin R. , Hijal, Tarek , Movsas, Benjamin
Journal of Clinical Oncology | May 11, 2026 | Volume: 44 | Issue: 19 | Pages: 1798-1811
PURPOSE For patients with breast cancer undergoing breast conservation, escalating the dose (boost) of radiation to the lumpectomy cavity after whole-breast irradiation (WBI) reduces ipsilateral breast recurrence (IBR) but extends treatment duration. This phase III trial investigated whether boost delivery during WBI versus after WBI provides noninferior IBR and preserves cosmetic appearance. METHODS NRG/RTOG 1005 randomly assigned patients at higher risk for IBR after lumpectomy and axillary surgery to either a sequential boost of 12 Gy in six fractions(F) or 14 Gy in 7F after WBI of 50 Gy in 25F or 42.7 Gy in 16F (sequential arm) or a concurrent boost of 8 Gy in 15F of 0.53 Gy per day with WBI of 40 Gy in 15F (concurrent arm) using 3-dimensional conformal radiation therapy (RT) or intensity-modulated RT. Based on 1.59% 5-year IBR for the sequential arm, defining the noninferiority margin as a hazard ratio upper limit on the 90% CI of 2.12, 2,312 patients provide 80% power for noninferiority of IBR as first recurrence for the concurrent arm. Secondary end points included disease-free survival and overall survival, adverse events (AEs), and cosmetic outcomes. RESULTS Between May 24, 2011, and June 20, 2014, 2,354 patients were randomly assigned, with 2,255 eligible for analysis (sequential arm, n = 1,118; concurrent arm, n = 1,137). With median follow-up of 7.3 years, there were 56 IBR events; 5- and 7-year IBR were 2.1% and 2.2% on the sequential arm and 1.9% and 2.6% on the concurrent arm, respectively. The noninferiority criterion was met: HR (90% CI): 1.31 (0.84 to 2.04), P = .037. No differences were observed in AEs, cosmetic outcomes, or survival between arms. CONCLUSION Concurrent boost during WBI results in noninferior IBR compared with sequential boost without worsening toxicity or cosmetic outcomes and reduces overall treatment time.