Local Regional Recurrence Among Patients With Pleomorphic Lobular Carcinoma In Situ: Is There a Role for Radiation Therapy?

Fasola, C.; Jensen, Kristin C.; Horst, K.C.

doi:10.1016/j.ijrobp.2012.07.618

Cited by 7 publications

(8 citation statements)

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“…The risk of concurrent invasive disease was based on the pooled data from seven studies, involving 93 patients [3,4,[30][31][32][33][34] . All patients were women, with a mean age of 58.4 years at PLCIS diagnosis (age range 35-84 years).…”

Section: Incidence Of Concurrent Invasive Diseasementioning

confidence: 99%

“…There are three articles reporting recurrence rates following excision of PLCIS [5,30,35] . Downs-Kelly et al [5] report a retrospective series of 26 patients with PLCIS on surgical excision.…”

Section: Recurrence Rate Of Diseasementioning

confidence: 99%

“…Fasola et al [30] assessed whether there is a potential role for radiation therapy in PLCIS by looking at the comparative recurrence rates [30] . However, they demonstrated no significant difference between the radiation therapy and non-radiation therapy groups.…”

Section: Adjuvant Therapy For Plcismentioning

confidence: 99%

“…The margin status for PLCIS recurrences and the time to recurrencesare not reported. Fasola et al [30] consider the role of radiotherapy in PLCIS, comparing 13 patients with a diagnosis of PLCIS alone and 21 patients with PLCIS in the setting of invasive carcinoma. Patients with PLCIS alone were more frequently treated with lumpectomy as opposed to mastectomy (85% vs 43%, P = 0.03) and none of the PLCIS only patients received adjuvant radiotherapy or chemotherapy compared to 16 (76%) of the patients with PLCIS and invasive disease receiving radiotherapy and/or chemotherapy.…”

mentioning

confidence: 99%

“…However, they conclude that this increased rate of recurrence may be a result of the to invasive disease on surgical specimen, data from five of the studies were used (in two studies, the correlation between core biopsy specimen and respective surgical specimen is unclear [30,31] ). Of 42 patients with PLCIS only on core biopsy, 14 were upstaged to invasive carcinoma on surgical specimen histology (33%).…”

mentioning

confidence: 99%

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Pleomorphic lobular carcinoma in situ of the breast: Can the evidence guide practice?

Pieri

Harvey

Bundred

2014

WJCO

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The clinical significance of pleomorphic lobular carcinoma in situ (PLCIS) is a subject of controversy. As a consequence, there is a risk of providing inconsistent management to patients presenting with PLCIS. This review aims to establish whether the current guidelines for the management of PLCIS are consistent with current evidence. A systematic electronic search was performed to identify all English language articles regarding PLCIS management. The data was analysed, specifically looking at: incidence of concurrent disease, recurrence rates, long-term prognosis and PLCIS management. A search was also performed for PLCIS management guidelines for the United Kingdom, United States, Canada, Australia, Germany and pan-European. The results of the evidence analyses were compared to the guidelines in order to establish whether the recommended management is consistent with the published evidence. Nine studies (level 3-4 evidence), involving a total of 176 patients and five management guidelines (from United Kingdom, United States, Australia and pan-European) were included in the review. From the evidence, 46 of 93 (49%) patients were found to have PLCIS with concurrent invasive disease on excision specimen analysis. Regarding recurrence rates, 11 of 117 (9.4%) patients developed a recurrence of PLCIS. There were no instances of invasive disease or ductal carcinoma in situ (DCIS) on recurrence histology. There were no studies assessing long-term outcomes in PLCIS cases. With regards to the management guidelines, the Association of Breast Surgery (United Kingdom) and the National Breast and Ovarian Cancer Care (Australia) do not mention PLCIS. The National Comprehensive Cancer Network (United States) suggest considering excision of PLCIS with negative margins. The NHS Breast Screening Programme (United Kingdom) and the European Society of Medical Oncology (pan-European) recommend PLCIS should be treated as with DCIS. We conclude that high quality evidence to inform guidance is lacking, thus recommendations are relatively vague. However, based on the available evidence, it would seem prudent to treat PLCIS in a similar manner to DCIS. is a breast lesion, the clinical significance of which is a subject of controversy. To date, this systematic review is the largest pooled series of clinical data regarding PLCIS. We aimed to establish whether current guidelines for management are consistent with the evidence. The results demonstrate a lack of high quality data and guidelines for management are variable. Analysis revealed a high incidence of concurrent invasive disease with PLCIS (49%) and following excision, a recurrence rate of 9.4%. We conclude that it would seem prudent

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