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Breast: Tumour-bed boost

Free question published 10 August 2026

BreastTumour-bed boost

A 38-year-old woman has had breast-conserving surgery for a 22 mm, grade 3, ER-positive, HER2-negative invasive ductal carcinoma with clear margins and negative sentinel nodes. She is to receive adjuvant whole-breast radiotherapy. She asks whether anything can be added to reduce her chance of the cancer coming back in the breast. What is the most appropriate advice regarding a tumour-bed boost?

  1. AA boost is only of value in node-positive disease
  2. BA boost improves overall survival but not local control
  3. CA tumour-bed boost should be offered, with the largest absolute benefit in young patients
  4. DA boost offers no reduction in local recurrence at any age
  5. EA boost is contraindicated in women under 40 because of poor cosmesis

Why C is correct

The EORTC 22881-10882 trial showed a 16 Gy tumour-bed boost reduced the 20-year cumulative incidence of ipsilateral breast tumour recurrence from 16.4% to 12.0%, with the largest absolute benefit in young patients (aged 40 years or younger). NICE NG101 recommends offering a boost to those at high risk of local recurrence, which includes young women with high-grade disease.

And why the others are not

  • AIncorrect. The boost benefit relates to local recurrence risk regardless of nodal status, not to node-positive disease specifically.
  • BIncorrect. The boost improved local control but did not improve overall survival.
  • DIncorrect. The boost significantly reduced ipsilateral breast tumour recurrence across all age groups in the EORTC trial.
  • EIncorrect. A boost is not contraindicated in young women; although it modestly affects cosmesis, the local-control benefit is greatest in this group.

Source EORTC 22881-10882 boost vs no boost - tumour-bed boost (20-year follow-up) — Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16(1):47-56.

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