The Japanese Breast Cancer Society Clinical Practice Guideline for radiation treatment of breast cancer, 2018 edition

Chikako Yamauchi,Etsuyo Ogo,Kenji Sekiguchi,Shigehira Saji,Hiroji Iwata,Naomi Nakajima,Naoko Sanuki,Yasushi Hamamoto,Masahiko Oguchi,Michio Yoshimura

doi:10.1007/s12282-019-01019-5

Abstract

PurposeThe Japanese Breast Cancer Society (JBCS) Clinical Practice Guideline was revised in 2018. This article describes the revise points in the section on radiation therapy (RT).Methods and materialsThe JBCS formed task force to update the JBCS Clinical Practice Guideline 2015 edition. Background questions (BQs) deal with standard treatments of breast cancer in clinical practice. Clinical questions (CQs) highlight the important treatments in which controversy remains. The task force for RT section addressed the 10 BQs, the 10 CQs, and the 4 Future reseach questions (FQs). For each CQ, systematic literature reviews and meta-analyses were conducted, and recommendations, strength of recommendation and strength of evidence were determined according to the protocol in Morizane et al. (Minds Handbook for Clinical Practice Guideline Development, 2014).ResultsThe recommendations, the strength of recommendation and the strength of evidence were determined based on the systematic literature reviews and the meta-analyses for each CQ.ConclusionThe JBCS updated the Clinical Practice Guideline. RT represents a significant portion of the breast cancer treatment, and these recommendations regarding RT will be useful in individualized, shared decision making between physicians and patients.

Highlights

The Japanese Breast Cancer Society (JBCS) Clinical Practice Guideline was revised in 2018
Boost irradiation to the tumor bed is weakly recommended for patients with pathologically negative margins who underwent breastconserving surgery (BCS) for invasive breast cancer [strength of recommendation (SoR): 2, strength of evidence (SoE): moderate]
The 10-year overall recurrence rate decreased from 45.7 to 34.2% after performing postmastectomy radiation therapy (PMRT) (RR 0.68, 95% CI 0.57–0.82, 2p = 0.00006), and the 20-year breast cancer death rate decreased significantly from 50.2 to 42.3% (RR 0.80, 95% CI 0.67–0.95, 2p = 0.01)

Summary

Introduction

The Japanese Breast Cancer Society (JBCS) Clinical Practice Guideline was revised in 2018. Boost irradiation to the tumor bed is weakly recommended for patients with pathologically negative margins who underwent BCS for invasive breast cancer [SoR: 2, SoE: moderate].

Results

Conclusion