Articles by Sharad Goyal, MD
ACR Appropriateness Criteria® Ductal Carcinoma in Situ
BySeth A. Kaufman, MD,Eleanor E. R. Harris, MD,Lisa Bailey, MD,Manjeet Chadha, MD,Sharon C. Dutton, MD,Gary M. Freedman, MD,Sharad Goyal, MD,Michele Y. Halyard, MD,Kathleen C. Horst, MD,Kristina L. M. Novick, MD,Catherine C. Park, MD,W. Warren Suh, MD,Deborah Toppmeyer, MD,Jennifer Zook, MD,Bruce G. Haffty, MD Management of ductal carcinoma in situ (DCIS) commonly involves excision, radiotherapy, and hormonal therapy. Radiotherapy is employed for local control in breast conservation. Evidence is evolving for several radiotherapy techniques exist beyond standard whole-breast irradiation.
This management guide covers the diagnosis and treatment of early-stage breast cancers, including lobular carincoma in situ (LCIS), ductal carcinoma in situ (DCIS), and both noninvasive and invasive disease.
Breast Cancer Overview: Risk Factors, Screening, Genetic Testing, and Prevention
ByLori Jardines, MD,Sharad Goyal, MD,Paul Fisher, MD,Jeffrey Weitzel, MD,Melanie Royce, MD, PhD,Shari B. Goldfarb, MD This management guide covers the risk factors, symptoms, screening, diagnosis, prevention, and staging of breast cancer.
Stages III and IV Breast Cancer
ByLori Jardines, MD,Sharad Goyal, MD,Melanie Royce, MD, PhD,Ishmael Jaiyesimi, DO,Shari B. Goldfarb, MD This chapter addresses the diagnosis and management of locally advanced, locally recurrent, and metastatic breast cancer, that is, stages III and IV disease.
This management guide covers the treatment of stage II breast cancer, malignancies with primary tumors > 2 cm that involve ipsilateral axillary lymph nodes and tumors ≤ 5 cm without nodal involvement.
The incorporation of molecular subtypes into the locoregional management of breast cancer has lagged behind its use in systemic therapy. Omission or dose-intensification of RT based on subtypes should be investigated in future trials.
ACR Appropriateness Criteria® Local-Regional Recurrence (LRR) and Salvage Surgery-Breast Cancer
ByMichele Y. Halyard, MD,Eleanor E. R. Harris, MD,Lisa Bailey, MD,Jennifer R. Bellon, MD,Gary M. Freedman, MD,Sharad Goyal, MD,Kathleen C. Horst, MD,Meena S. Moran, MD,Catherine C. Park, MD,W. Warren Suh, MD,Deborah Toppmeyer, MD,Bruce G. Haffty, MD Management recommendations for breast cancer local-regional recurrence (LRR), including patient scenarios, are reviewed, and represent evidence-based data and expert opinion of the American College of Radiology Appropriateness Criteria Expert Panel on LRR.
Breast-conservation therapy (BCT), consisting of lumpectomy followed by whole-breast irradiation (WBI), is the standard of care for women with early-stage breast cancer. However, many women who are candidates for BCT either choose mastectomy or lumpectomy alone for myriad reasons. Accelerated partial-breast irradiation (APBI) is a collection of radiotherapy techniques that deliver higher daily doses of radiation to the surgical cavity with margin over a shorter time than WBI, reducing total treatment time from 6-6.5 weeks to 1-2 weeks. Advocates of APBI state that early results of this approach demonstrate excellent local control, minimal acute toxicity, and are associated with more convenience for the patient. Phase III randomized clinical trials are currently underway to assess local control, acute and chronic toxicities, and quality of life associated with APBI compared to WBI. In this review, we hope to clarify the rationale behind APBI and discuss in depth data concerning various partial-breast irradiation techniques that are being used throughout the United States and around the world.
