The NCCN 2021 guidelines for invasive breast cancer list absolute and relative contraindications to breast conserving therapy with postoperative radiation.
Patient selection: invasive breast cancer
Absolute contraindications:
(1) pregnancy (for the radiation therapy, which can be given postpartum)
(2) diffuse microcalcifications that are suspicious for or malignant appearing (diffuse DCIS)
(3) widespread disease that cannot be incorporated into a single excision, assure negative margins and have a satisfactory cosmetic result
(4) diffusely positive pathologic margins
(5) homozygous mutations for ATM (with biallelic inactivation)
Relative contraindications:
(1) prior radiation therapy to the chest wall or breast (if previous doses were maximal for site)
(2) active connective tissue disease (SLE, scleroderma) that is involving skin
(3) persistently positive pathologic margins
(4) known or suspected genetic predisposition to breast cancer
where:
• A patient with a genetic predisposition to breast cancer may be at increased risk for recurrent ipsilateral and contralateral breast cancer. Bilateral mastectomy may be more appropriate for risk reduction.
