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NCCN Guidelines for Patients


Breast Cancer - Early-Stage


, Version 1.2016


Radiation therapy

Treatment options after lumpectomy

Treatment options after lumpectomy

Chart 5.1 Radiation guide

Results of lymph node surgery Where do I need radiation?

No cancer in axillary nodes

• Whole breast with or without added boost to tumor site,

• Part of the breast for some women,


• No radiation is needed if all of these factors describe you:


You are 70 years old or older,


The breast tumor was smaller than 2 cm,


The cancer cells are hormone receptor–positive, and


You will be taking endocrine therapy.

Cancer in 1 to 3 axillary nodes

• Whole breast with or without added boost to tumor site,


• Strongly consider treating supraclavicular and infraclavicular areas,

internal mammary lymph nodes, and axillary areas at risk for cancer.

Cancer in 4 or more axillary nodes

• Whole breast with or without added boost to tumor site,

• Supraclavicular and infraclavicular areas,

• Internal mammary lymph nodes,


• Axillary areas at risk for cancer.

Chart 5.1

lists options for radiation therapy after

having a lumpectomy. Options are based on how

many axillary lymph nodes have cancer. Radiation

to the breast is given only after cancer-free surgical

margins have been removed. Possible radiation

sites are shown in

Figure 5.1


Most women with cancer-free nodes receive

radiation to the whole breast. This is called whole

breast radiation. Toward the end of radiation, you

may receive extra radiation called a boost if the

cancer is likely to return after treatment.

Some women with cancer-free nodes receive

partial breast irradiation. Partial breast irradiation is

radiation given only to the lumpectomy site. More

research is needed to know how well this treatment


If you’re interested, it may be best to receive partial

breast irradiation within a clinical trial. Outside of

a clinical trial, partial breast irradiation is safest in

treating breast cancer among women 1) who are

60 years of age or older; 2) with hormone receptor–

positive ductal carcinoma that is confined to a small

area with the breast; and 3) treated with surgery

that had cancer-free surgical margins.