Absolute contraindications:
(1) pregnancy (breast conserving surgery can be performed in third trimester with irradiation after delivery)
(2) two or more primary tumors in separate quadrants (multicentric disease)
(3) diffuse malignant-appearing microcalcifications
(4) previous history of irradiation to breast, which, when added to current radiation dosage requirements results in a dose that exceeds the safe total irradiation for the area
(5) persistent positive surgical margins after reasonable surgical attempts
Relative contraindications:
(1) presence of a collagen vascular disease such as active lupus erythematosus or scleroderma (exception: rheumatoid arthritis)
(2) multiple gross tumors in the same quadrant and indeterminate calcifications
(3) large tumor in a small breast for which resection would result in poor cosmesis
(4) women with large or pendulous breasts, unless reproducibility of irradiation can be ensured by precise patient set-up
(5) unwillingness or inability to be treated with radiation
(6) medical contraindication to radiation
(7) inability to localize primary tumor secondary to a complete clinical response to neoadjuvant chemotherapy
