Is Radiation Indicated in Patients With Ductal Carcinoma In Situ and Close or Positive Mastectomy Margins?

Chan, Linda W.; Rabban, Joseph T.; Hwang, E. Shelley; Bevan, Alison; Alvarado, Michael; Ewing, Cheryl A.; Esserman, Laura J.; Fowble, Barbara

doi:10.1016/j.ijrobp.2010.01.044

Cited by 40 publications

(25 citation statements)

References 44 publications

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“…Other risk factors are contradictive in the literature, such as high nuclear grade, close (<3-2 mm) or positive margins, multifocal disease and/or large tumor size [9,13,15,21,22,24,28], yet none of these were shown to be statistically significant in our study. A history of previous contralateral breast cancer seemed to predispose to recurrence, however, given the very low number of patients in this category, we hesitate to present this as a well-proven risk factor.…”

Section: Discussioncontrasting

confidence: 91%

“…Two studies [13,20] described an increased LRR rate (5%) associated with skin-sparing mastectomy in the context of breast reconstruction, as compared to simple mastectomy. In the study of Carlson et al [20], all recurrences had previous close margins or high-grade disease, suggesting that high-risk characteristics might be the cause of recurrence rather than the type of mastectomy.…”

Section: Discussionmentioning

confidence: 99%

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The locoregional recurrence post-mastectomy for ductal carcinoma in situ: Incidence and risk factors

et al. 2015

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Section: Discussioncontrasting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

The locoregional recurrence post-mastectomy for ductal carcinoma in situ: Incidence and risk factors

et al. 2015

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“…Pathological review of the original mastectomy blocks did not identify any invasive disease at the time of diagnosis. In contrast, it has been reported (10) that margin status was only a significant factor for recurrence for patients treated with BCS and not after mastectomy, leading others to suggest that the risk of chest wall recurrence was too low to recommend adjuvant radiotherapy (13).…”

Section: Discussionmentioning

confidence: 88%

Radiotherapy after mastectomy for screen-detected ductal carcinoma in situ

Clements

Dodwell

Lawrence

et al. 2015

European Journal of Surgical Oncology (EJSO)

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“…A retrospective review of 223 patients with DCIS treated by SSM and IBR, the same author reported an LR rate of 3.3%, with high tumour grade and surgical margins <1 mm as risk factors with a mean follow-up of 82 months [69]. Finally, in a retrospective long-term follow-up study of 44 patients who underwent SSM and IBR for DCIS, there were no local or distant recurrences after 9.8 years [73]. These retrospective studies have all demonstrated that SSM and IBR for DCIS is oncologically safe with low local recurrence rates.…”

Section: Ssm For Dcismentioning

confidence: 93%

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

Kasem¹,

Choy²,

Mokbel³

2014

JCT

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Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC < 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nippleareola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New techniques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.

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Is Radiation Indicated in Patients With Ductal Carcinoma In Situ and Close or Positive Mastectomy Margins?

Cited by 40 publications

References 44 publications

The locoregional recurrence post-mastectomy for ductal carcinoma in situ: Incidence and risk factors

The locoregional recurrence post-mastectomy for ductal carcinoma in situ: Incidence and risk factors

Radiotherapy after mastectomy for screen-detected ductal carcinoma in situ

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

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