The 18th St.Gallen International Breast Cancer Conference (SGBCC 2023) took place in Vienna, known as the “City of Music”, from March 15th to 18th, 2023, local time. SGBCC brought together breast cancer opinion leaders from all over the world to discuss and vote on the most cutting-edge and controversial topics regarding early-stage breast cancer treatment. This culminates in the St.Gallen early-stage breast cancer international expert consensus, which is updated every two years. On the last day of the conference, the expert voting was the highlight. Oncology Frontier has compiled the expert votes on early-stage breast cancer radiotherapy as follows:
Radiotherapy
(1)The preferred radiation schedule for…
1.chest wall irradiation irrespective of nodal irradiation after mastectomy
2.whole breast irradiation, irrespective of nodal irradiation, after breast conserving surgery for invasive cancer
3.whole breast irradiation after breast conserving surgery for DCIS
SGBCC Expert Voting:
(2) For routine radiation therapy for early breast cancer, there is at present no clinical advantage to proton therapy over photon therapy. This view is:
1. True
2. False
3. Abstain
SGBCC Expert Voting:
(3)A boost dose to the primary tumour bed after breast conserving surgery s indicated in:
1. Patients with at least 1 of the 4 following prognostic factors: high-grade cancers,extensive intraductal component (EIC): TNBC or HER2-positive subtypes; age below 50 years
2. Patients who have at least 2 of the 4 following prognostic factors: high-gradecancers; extensive intraductal component (EIC): TNBC or HER2-positive subtypes;age below 50 years
3. Patients who have at least 3 of the 4 following prognostic factors: high-gradecancers; extensive intraductal component (EIC): TNBC or HER2-positive subtypes;age below 50 years
4. Patients who have all 4 following prognostic factors: high-grade cancers; extensiveintraductal component (EC): TNBC or HER2positive subtypes; age below 50 years
5.I have other criteria.
6. Abstain.
SGBCC Expert Voting:
(4) A boost dose to the primary tumour bed after breast conserving surgery can be omitted if a pCR in the breast was obtained with preoperative systemic therapy.
1. Yes
2. Yes in baseline clinical stage 1 or 2 but not stage3
3. No
4. Abstain
SGBCC Expert Voting:
(5) A healthy postmenopausal woman has been diagnosed with clinical stage 1 breast cancer. Imaging studies suggest no axillary disease. The tumor is 1.3 cm in size, strongly ER and PR positive and low grade (1 of 3). SLN surgery is performed without evidence of cancer in the SLNs. The patient will be adherent with endocrine treatment. The age at which whole breast radiation therapy may appropriately be omitted is:
1. >55
2. >60
3. >65
4. >70
5. >75
6. Offer radiation therapy of age if live expectancy > 15 years
7. Abstain
SGBCC Expert Voting:
Audience Voting:
(6) The most important clinical implication from the PRIME-II trial is that:
1. Radiation lowers in-breast recurrence and therefore is effective
2. Radiation does not alter survival, and therefore can be omitted
3. Abstain.
SGBCC Expert Voting:
(7) A postmenopausal woman has undergone mastectomy and axillary surgery for a T2 breast cancer with nodal involvement as below. The tumor is ER positive, and there is micrometastatic cancer in 1 lymph node. Would you recommend postmastectomy radiation therapy?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(8) A postmenopausal woman has undergone mastectomy and axillary surgery for a T2 breast cancer with nodal involvement as below. The tumor is ER positive, and there is cancer in 1 lymph node. Would you recommend postmastectomy radiation therapy?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(9) A postmenopausal woman has undergone mastectomy and axillary surgery for a T2 breast cancer with nodal involvement as below. The tumor is ER positive, and there is cancer in 2 lymph nodes. Would you recommend postmastectomy radiation therapy?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(10)A postmenopausal woman has undergone mastectomy and axillary surgery for a T2 breast cancer with nodal involvement as below. The tumor is ER positive, and there is cancer in 3 lymph nodes. Would you recommend postmastectomy radiation therapy?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(11) A postmenopausal woman has undergone mastectomy and axillary surgery for a T3 breast cancer with nodal involvement as below. The tumor is ER positive, and the lymph nodes are negative. Would you recommend postmastectomy radiation therapy?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(12) A postmenopausal woman has undergone mastectomy and axillary surgery for a T2 breast cancer with nodal involvement as below. The tumor is HER2 positive, and there is micrometastatic cancer in 1 lymph node. Would you recommend postmastectomy radiation therapy?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(13) A postmenopausal woman has undergone mastectomy and axillary surgery for a T2 breastcancer with nodal involvement as below.The tumor is HER2 positive, and there is cancer in 1 lymph node. Would you recommend postmastectomy radiation therapy?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(14)A postmenopausal woman has undergone mastectomy and axillary surgery for a T2 breast cancer with nodal involvement as below. The tumor is TNBC, and there is micrometastatic cancer in 1 lymph node. Would you recommend postmastectomy radiation therapy?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(15) A patient is found to have a heterozygous deleterious mutation in the ATM gene. Is this a contraindication to radiotherapy after breast conserving surgery?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
SGBCC Expert Voting, which one do you pick?
Due to formatting limitations, we have chosen a few topics for readers to vote on, to experience the St. Gallen atmosphere of early breast cancer treatment decision-making. The question stem is abbreviated; for specific content, please refer to the text above.
1. After breast-conserving surgery, the boost radiotherapy to the primary tumor bed is suitable for: (single choice)
• At least 1 of the following: high grade; extensive EIC; TNBC or HER2+; <50 years old
• At least 2 of the following: high grade; extensive EIC; TNBC or HER2+; <50 years old
• At least 3 of the following: high grade; extensive EIC; TNBC or HER2+; <50 years old
• All 4 prognostic factors: high grade; extensive EIC; TNBC or HER2+; <50 years old
• I have other criteria
• Abstain
2. After breast-conserving surgery for patients with breast pCR, can the tumor bed boost radiotherapy be avoided? (single choice)
• Yes
• Clinical stage 1 or 2 is “Yes”, stage 3 is “No”
• No
• Abstain
3. For such low-risk patients, the age at which whole breast radiotherapy can be appropriately avoided is: (single choice)
• >55 years old
• >60 years old
• >65 years old
• >70 years old
• >75 years old
• If the expected lifespan is >15 years, radiotherapy can be administered
• Abstain
4. Postmenopausal, Stage T2, ER+, 2 positive ALN, do you recommend post-operative radiotherapy? (single choice)
• Yes
• No
• Abstain
5. Postmenopausal, Stage T3, ER+, ALN negative, do you recommend post-operative radiotherapy? (single choice)
• Yes
• No
• Abstain
“SGBCC Voting Scene (Photo:Maple Leaf)”
