Table 2 Summary of the prognostic implications, adjuvant treatment recommendations, and associated cost estimates of PSM for individual tumor sites: breast, prostate, bladder, colon and rectum, thyroid, oral cavity, lung and bronchus, uterine.

Prognostic Implications for PSM

Increased LRR, decreased DSS

Increased risk of biochemical recurrence; no impact on cancer-specific mortality

Increased LRR, Decreased DSS

Increased LRR and DM, decreased DFS and OS

Adjuvant Treatment Recommendations for PSM based on NCCN Guidelines

Early Stage

PSM after lumpectomy:

Re-excision

OR

Mastectomy

OR

Higher RT boost for focal PSM without extensive intraductal component

RT

Stage II (T2N0)

RT,

OR

Chemo (if no neoadjuvant therapy) Stage II (T2N0) primary urethra carcinoma (males):

Re-resection

Or

CRT (preferred)

Or

RT

Colon:

larger resection, T3N0M0 chemo,

and for any stage consider boost radiation

Late Stage

PSM after mastectomy:

Consider RT to chest wall +/− infraclavicular region +/− supraclavicular area +/− internal mammary nodes &any part of axillary bed at risk

RT

Stage III-IV (T3–4, N0-2) urothelial:

Higher RT boost

Rectum: larger resection, T1Nx after trans-anal excision:

Transabdominal resection +/− CRT

or CRT, and intra-operative radiation therapy (IORT) may be considered for PSM especially in T4 and recurrent cancers

Cost of Adjuvant Treatment due to PSM

Surgery

Lumpectomy alone: $70,520

Mastectomy alone: $48,258

Mastectomy + Recon: $88,089

Radiation

RT: $8,600

RT: $18,000

Chemotherapy

Chemo: $16,416

Chemo: $17,833

THYROID

ORAL CAVITY

LUNG & BRONCHUS

UTERINE

Prognostic Implications for PSM

No impact

Increased LRR, Decreased OS

Decreased OS

Potential increase in LRR

Adjuvant Treatment Recommendations for PSM based on NCCN guidelines

Early Stage

PSM after partial thyroidectomy (papillary): Completion thyroidectomy

STAGE I-II:

Re-resection

OR

RT

OR

CRT (T2 only)

STAGE IA:

Re-resection (preferred)

OR

RT (category 2B)

STAGE IB-IIA (node-negative):

Re-resection (preferred) +/− chemo

OR

RT +/− chemo (chemo for stage IIA)

STAGE IIA-B (node-positive):

Re-resection+ chemo

OR

CRT

Vaginal brachytherapy and/or RT for stage I after extrafascial hysterectomy

Late Stage

STAGE III-IV

CRT (category 1)

OR

Re-resection

OR RT

STAGE IIIA: CRT

T1, Nx rectal after trans-anal excision:

Transabdominal resection +/− CRT

OR

CRT

Cost of Adjuvant Treatment due to PSM

Surgery

Surgery: $5,617

Surgery: $24,595

Surgery: $15,034

Radiation

RT: $21,300

RT: $9,000

RT: $9066

Brachytherapy: $7233

Chemotherapy

Chemo + RT: $27,928