Breast-conserving therapy for ductal carcinoma in situ of the breast: the French Cancer Centers’ experience

Cutuli, B.; Nir, C. Cohen-Solal-Le; Lafontan, B. De; Mignotte, H.; Fichet, V.; Fay, Renaud; Servent, V.; Giard, S.; Charra-Brunaud, C.; Lemanski, C.; Auvray, H.; Jacquot, S.; Charpentier, Jean-Christophe

doi:10.1016/s0360-3016(02)02834-1

Cited by 120 publications

(89 citation statements)

References 71 publications

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“…16 In retrospective series, younger age also has been identified as a risk factor for ipsilateral recurrence. [34][35][36][37][38] Our data confirm these findings: younger patients (<50 years) were more likely to develop a local recurrence. This age difference could not be attributed to different treatment strategies: no difference in mean age was found in the mastectomy and breast-conserving surgery groups.…”

Section: Discussionsupporting

confidence: 86%

Local Recurrences After Conservative Treatment of Ductal Carcinoma-In-Situ of the Breast Without Radiotherapy: The Effect of Age

et al. 2006

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Background: The main goal in treatment of ductal carcinoma-in-situ (DCIS) of the breast is to prevent local recurrences. Radiotherapy after breast-conserving surgery has been shown to decrease the recurrence rate, although whether all patients should be treated with radiotherapy remains a topic of debate. The aim of this study was to assess the local recurrence rate after conservative surgical treatment of DCIS without radiotherapy and to identify risk factors for local recurrence.Methods: A total of 499 female patients with 502 DCIS lesions treated in the period 1989 to 2002 were retrospectively reviewed. Survival rates were calculated by the Kaplan-Meier method, and differences were tested by using the log-rank test. The association of variables with local recurrence was analyzed by using the v 2 test. Results: Treatment constituted of lumpectomy in 329 patients (65%). Thirty-eight patients (8%) had disease-positive margins, and for 41 patients (8%) the margin status was not known. Eighty tumors recurred, for a local recurrence rate of 13% after 4 years compared with 17% for patients treated with breast-conserving surgery only. Risk factors for ipsilateral recurrences were younger age (<50 years), treatment with breast-conserving surgery only, and presence of disease-involved surgical margins.Conclusions: Conservative treatment of DCIS results in high recurrences rates, and outcomes can be improved by performing more radical surgery. Because radiotherapy has been shown to be effective in preventing recurrent disease, and, to date, no subgroups have been identified in which radiation can be omitted, its use is recommended, especially in younger patients.

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Section: Discussionsupporting

confidence: 86%

Local Recurrences After Conservative Treatment of Ductal Carcinoma-In-Situ of the Breast Without Radiotherapy: The Effect of Age

et al. 2006

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“…However, this rate was much higher (58%) in a large series from the Netherlands Cancer Institute (Meijnen et al, 2008). Tumour Table 3 Influence of tumour size, nuclear grade, necrosis and age on treatment modality (number and percent patients) (Fisher et al, 2001;Solin et al, 2001;Cutuli et al, 2002;Fourquet et al, 2002;Vicini and Recht, 2002;Bijker et al, 2006). These data probably explain our 50% mastectomy rates in women under the age of 40 years.…”

Section: Discussionmentioning

confidence: 87%

“…In four randomized controlled trials, the LR rates after CS without RT were 32, 28, 26 and 22%, with follow-ups ranging from 52 to 120 months (Fisher et al, 2001;Hougton et al, 2003;Bijker et al, 2006;Holmberg et al, 2008). In a French study, the 7-year LR rate was 32.4% in patients not receiving RT (Cutuli et al, 2002). In two latest Dutch studies (Schouten Van Der Velden et al, 2007;Meijnen et al, 2008), the 8-and 10-year LR Survey of DCIS in France B Cutuli et al after CS alone were 15.6 and 25%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…In two latest Dutch studies (Schouten Van Der Velden et al, 2007;Meijnen et al, 2008), the 8-and 10-year LR Survey of DCIS in France B Cutuli et al after CS alone were 15.6 and 25%, respectively. Whole breast irradiation at 50 Gy after CS for DCIS halved in situ and invasive recurrence rates in earlier quoted trials (Fisher et al, 2001;Hougton et al, 2003;Bijker et al, 2006;Emdin et al, 2006;Holmberg et al, 2008) and several large retrospective studies (Solin et al, 2001;Cutuli et al, 2002;Fourquet et al, 2002;Schouten Van Der Velden et al, 2007;Meijnen et al, 2008). On the other hand, RT administration after wide excision (margins 41 cm) of small low-grade lesions is questioned (Cornfield et al, 2004;MacDonald et al, 2005;Solin et al, 2006;Buchholz et al, 2007, Silverstein et al, 2007.…”

Section: Discussionmentioning

confidence: 99%

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Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

et al. 2009

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physicians throughout France prospectively recruited 1289 ductal carcinoma in situ (DCIS) patients and collected data on diagnosis, patient and tumour characteristics, and treatments. Median age was 56 years (range, 30 -84). Ductal carcinoma in situ was diagnosed by mammography in 87.6% of patients. Mastectomy, conservative surgery alone (CS) and CS with radiotherapy (CS þ RT) were performed in 30.5, 7.8 and 61.7% of patients, respectively. Thus, 89% of patients treated by CS received adjuvant RT. Sentinel node biopsy (SNB) and axillary dissection (AD) were performed in 21.3 and 10.4% of patients, respectively. Hormone therapy was administered to 13.4% of the patients (80% tamoxifen). Median tumour size was 14.5 mm (6, 11 and 35 mm for CS, CS þ RT and mastectomy, respectively, Po0.0001). Nuclear grade was high in 21% of patients, intermediate in 38.5% and low in 40.5%. Excision was considered complete in 92% (CS) and 88.3% (CS þ RT) of patients. Oestrogen receptors were positive in 69.8% of assessed cases (31%). Treatment modalities varied widely according to region: mastectomy rate, 20 -37%; adjuvant RT, 84 -96%; hormone treatment, 6 -34%. Our survey on current DCIS management in France has highlighted correlations between pathological features (tumour size, margin and grade) and treatment options, with several similar variations to those observed in recent UK and US studies.

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“…(Fisher, 1993), cosa que ha bajado la tasa de recidivas locales a un 8-15 % a los 10 años, en relación a la calidad de la exéresis quirúrgica, de la edad del paciente, el grado, y los sub-tipos histológicos. Los trials randomizados (exclusivos para los CCIS) National Surgical Adjuvant Breast and Bowel Project B17 (NSABP B-17), y European Organization for Research and Treatment of Cancer (EORTC) 10853 han comparado la tumorectomía versus la tumorectomía + radioterapia (50 Gy en un booster), y un trabajo multicéntrico retrospectivo francés (Cutuli, 2002) confirmó los beneficios de la irradiación después de la tumorectomía (sin modificación de la sobrevida).…”

Section: Standard De La Radioterapia En El Carcinoma In Situunclassified

Radioterapia adyuvante en el cáncer de mama

2004

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Breast-conserving therapy for ductal carcinoma in situ of the breast: the French Cancer Centers’ experience

Cited by 120 publications

References 71 publications

Local Recurrences After Conservative Treatment of Ductal Carcinoma-In-Situ of the Breast Without Radiotherapy: The Effect of Age

Local Recurrences After Conservative Treatment of Ductal Carcinoma-In-Situ of the Breast Without Radiotherapy: The Effect of Age

Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

Radioterapia adyuvante en el cáncer de mama

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