Institut Bergonié, Bordeaux.
Context: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Cancer Centers, and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Objectives: To develop clinical practice guidelines for non metastatic breast cancer patients according to the definitions of the Standards, Options and Recommendations project. Methods: Data were identified by searching Medline®, web sites, and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 148 independent reviewers. Results: This article is an update of the version published in 1996. The modified 2001 version of the standards, options and recommendations takes into account new information published. Important changes have been made in terms of clinical practice. They concern loco-regional and general therapy. Regarding loco-regional treatment, a increased dose to the tumor bed should be needs to be systematically delivered to the tumor bed for women under 50 years. The analysis of margin involvement is essential and constitutes an important factor for therapeutic decision. Regarding general therapy, hormone therapy with tamoxifen appeared, in 2001, as one of the standards in non-menopausal and oestrogen receptor-positive patients. Concerning patients with N- tumors, the standards and therapeutic options were refined with regard to the notion of metastatic relapse risk. Chemotherapy constitutes one of the standard treatments for non-menopausal women with one or more factor(s) predictive of metastatic relapse.