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Table 1 Inclusion criteria for guideline adherence based on the German national consensus guideline (S3 guideline) for the decisions regarding loco-regional treatment (surgery and radiotherapy), chemotherapy, and endocrine therapy

From: Adherence to treatment guidelines and survival in triple-negative breast cancer: a retrospective multi-center cohort study with 9156 patients

Group A – Surgical therapy

 

Breast conserving therapy (Reference: Statements 7, 8)

Conforming to guideline recommendations

Non-conforming to guideline recommendations

  BCT in DCIS and LCIS < 4 cm

  BCT when tumor size > 4 cm

  BCT in R0

  BCT in R1

  BCT in presence of multicentricity

  BCT in presence of inflammatory carcinoma

Mastectomy (Reference: Statement 9)

Conforming to guideline recommendations

Non-conforming to guideline recommendations

  Mastectomy for microcalcification of malignant type

  No mastectomy in the presence of microcalcification of malignant type

  Mastectomy for intraductal carcinoma and tumor size > 4 cm

  No mastectomy in the presence of multicentricity

  Mastectomy for multicentricity

  Mastectomy for intraductal carcinoma with a tumor size < 4 cm

  Mastectomy for R1

  No mastectomy for inflammatory breast cancer

  Mastectomy for inflammatory breast cancer

Axillary dissection (Reference: Statements 12, 13)

Conforming to guideline recommendations

Non-conforming to guideline recommendations

  Removal of invasive carcinoma + dissection for at least level I and II + removal of at least 10 lymph nodes

  Lymph node removal in non-invasive carcinoma

  

  Invasive carcinoma + (only dissection for level I or removal of <10 lymph nodes)

Group B – Radiotherapy

 

Radiotherapy secondary to BCT (Reference: Statements 23, 24)

Conforming to guideline recommendations

Non-conforming to guideline recommendations

  Radiotherapy secondary to BCT for invasive carcinoma

  No radiotherapy secondary to BCT for invasive carcinoma

Postmastectomy strategy (Reference: Statements 25, 26)

Conforming to guideline recommendations

Non-conforming to guideline recommendations

  Radiotherapy secondary to mastectomy and R1/R2

  Radiotherapy in mastectomy and R0

  Radiotherapy secondary to mastectomy and nodes involved ≥4

  Radiotherapy in mastectomy and T = T1 or T2

  Radiotherapy T = T3 or T4

  No radiotherapy in mastectomy and R1/R2

  No radiotherapy in mastectomy and nodes involved ≥4

  

  No radiotherapy in T = T3 or T4

Group C –Endocrine therapy

 

Endocrine therapy (Reference: Statements 33–37)

Conforming to guideline recommendations

Non-conforming to guideline recommendations

  Tamoxifen for invasive carcinoma in patients with positive hormone receptor status

  Hormone therapy in receptor-negative patients

  GnRH + tamoxifen or GnRH in premenopausal patients with positive hormone receptor status

  Postmenopausal patient and positive hormone receptor status and tamoxifen or aromatase inhibitor

  Endocrine therapy after chemotherapy in positive receptor status

  Tamoxifen for DCIS

When estrogen receptor (ER) and progesterone receptor (PgR) are negative:

Risk group

Chemotherapy

Guideline conformity

Low

CT performed

Overtherapy

 

No CT performed

Guideline conformity

Moderate

CMF/EC/AC

Undertherapy

 

FEC/T

Guideline conformity

 

No CT performed

Undertherapy

High

CMF/EC/AC

Undertherapy

 

FEC/T

Guideline conformity

 

No CT performed

Undertherapy

ER and PgR >0 and <6

Risk group

Chemotherapy

Guideline conformity

Low

CT performed

Overtherapy

 

No CT performed

Guideline conformity

Moderate

  

Premenopausal

CT performed

Guideline conformity

 

No CT performed

Guideline conformity

Postmenopausal

CT performed

Guideline conformity

 

No CT performed

Undertherapy

High

CMF/EC/AC

Undertherapy

 

FEC/T

Guideline conformity

 

No CT performed

Undertherapy

ER or PgR ≥6

Chemotherapy

Guideline conformity

Risk group

Low

CT performed

Overtherapy

 

No CT performed

Guideline conformity

Moderate

CT performed

Guideline conformity

 

No CT performed

Guideline conformity

High

CMF/EC/AC

Undertherapy

 

FEC/T

Guideline conformity

 

No CT performed

Undertherapy

  1. Risk group classification in the 2008 S3 guideline is according to Goldhirsch et al. [27].
  2. Key: CT, Chemotherapy; CMF, Cyclophosphamide, methotrexate, fluorouracil, EC/AC, Epirubicin, cyclophosphamide/adriamycin, cyclophosphamide, FEC, Fluorouracil, epirubicin, cyclophosphamide, T, Taxane.