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content pubmed pubmed citation articles by chenc nbsp eligibility ages eligible for study: nbsp 18 years and older genders eligible for study: nbsp female accepts healthy volunteers: nbsp no criteria disease characteristics: pathologically proven diagnosis of breast cancer resected by lumpectomy and whole-breast irradiation wbi with boost without regional nodal irradiation planned must meet one of the following criteria: stage i or ii breast cancer and at least one of the following: age < 50 years positive axillary nodes lymphovascular space invasion lvi at least 2 close resection margins > 0 mm to ≤ 2 mm one close resection margin and extensive in-situ component eic focally positive resection margins non-hormone-sensitive breast cancer estrogen-receptor negative er- and progesterone-receptor pr- negative grade iii histology oncotype recurrence score > 25 stage 0 breast cancer with nuclear grade 3 ductal carcinoma in situ dcis and patient age < 50 years no dcis and age > 50 years no dcis and age < 50 years and nuclear grade 1 or 2 resected by lumpectomy after neoadjuvant systemic therapy if multifocal breast cancer, then it must have been resected through a single lumpectomy incision with negative margins breast-conserving surgery with margins defined as follows: negative margins defined as no tumor at the resected specimen edge close resection margins > 0 mm to ≤ 2 mm as follows: one close resection margin and eic two or more close resection margins a focally positive resection margin allowable options for mandatory axillary staging include: sentinel node biopsy alone if sentinel node is negative, pn0, pn0 sentinel node biopsy alone, or followed by axillary node dissection, for clinically node-negative patients as described below: microscopic sentinel node sn positive pn1mic one or two sns positive pn1 without extracapsular extension negative sn biopsy after neoadjuvant chemotherapy sn biopsy followed by axillary dissection with a minimum total of 6 axillary nodes if any of the following exist: > 2 positive sn solitary sn that is positive without other sentinel nodes dissected clinically by either imaging or examination t3 disease presence of one or more positive sns with extracapsular extension, clinically node-positive disease, or lvi in the primary tumor axillary dissection alone with a minimum of 6 axillary nodes ct-imaging of the ipsilateral breast within 28 days of study entry for the radiation treatment planning must be able to delineate on ct scan the extent of the target lumpectomy cavity for boost placement of surgical clips to assist in treatment planning of the boost is strongly recommended no clinical evidence for distant metastases, based upon the following minimum diagnostic workup: history/physical examination, including breast exam inspection and palpation of the breasts and documentation of weight and zubrod performance status of 0-2 within 28 days prior to study entry bilateral mammogram within 90 days prior to study entry bilateral or right and left mammography within 90 days prior to neoadjuvant chemotherapy, diagnostic biopsy establishing diagnosis, or last surgery breast or axilla no prior invasive or in-situ carcinoma of the breast prior lcis is eligible no american joint committee on cancer ajcc pathologic t4, n2 or n3, or m1 breast cancer must not have two or more breast cancers that are not resectable through a single lumpectomy incision no invasive breast cancer and low-risk see low risk features below for 5-year in-breast recurrence after lumpectomy with negative margins, defined as: ≥ 70 years old, t1, n0, er/pr+ > 50 years old, t1, n0, grade 1-2 breast cancer, er/pr+ no suspicious unresected microcalcification, densities, or palpable abnormalities in the ipsilateral or contralateral breast unless biopsied and found to be benign no non-epithelial breast malignancies such as sarcoma or lymphoma no paget disease of the nipple no male breast cancer breast implants allowed patient 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