Long‐term outcome after breast‐conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast

Abstract

BACKGROUNDDuctal carcinoma in situ (DCIS) is detected most commonly on routine screening mammography in the asymptomatic patient, and has a long natural history. The objective of the current study was to determine the long‐term outcome after breast‐conservation surgery followed by definitive breast irradiation for women with mammographically detected DCIS of the breast.METHODSIn total, 1003 women with unilateral, mammographically detected DCIS of the breast underwent breast‐conserving surgery followed by definitive breast irradiation. These women were treated in 10 institutions in North America and Europe. The median follow‐up was 8.5 years (mean, 9.0 years; range, 0.2–24.6 years).RESULTSThe 15‐year overall survival rate was 89%, and the 15‐year cause‐specific survival rate was 98%. The 15‐year rate of freedom from distant metastases was 97%. In total, there were 100 local failures (10%) in the treated breast. The 15‐year rate of any local failure was 19%, and the 15‐year rate of local only first failure was 16%. Patient age ≥ 50 years at the time of treatment and negative final pathology margins from the primary tumor excision both were associated independently with a lower risk of local failure in univariate analysis (P = 0.00062 and P = 0.024, respectively) and in multivariate analysis (P = 0.00057 and P = 0.0026, respectively). For favorable subgroups of patients age ≥ 50 years or with negative resection margins, the 10‐year risk of local failure was ≤ 8%.CONCLUSIONSThe current results support the use of breast‐conserving surgery followed by definitive breast irradiation for the treatment of patients with mammographically detected DCIS of the breast. Patient age ≥ 50 years at the time of treatment and negative resection margins both were associated independently with a decreased risk of local failure. Cancer 2005. © 2005 American Cancer Society.

Management of Ductal Carcinoma In Situ Patients Receiving Postoperative Radiotherapy after Breast Conserving Surgery: Hacettepe Experience

“…At a median follow-up of 8.5 years there were only 100 LRs in the treated breast, yielding a 10-year actuarial LR rate of 10%. 19 The experience of the Institute Curie over a 30-year period (1967 to 1996) was reported. 20 Among 601 DCIS patients, 343 were treated with wide excision plus RT.…”

Radiation Therapy Following Breast Conserving Surgery for Ductal Carcinoma in situ: Yes or No?

“…In a study of Solin et al, patients with comedoarchitecture and nuclear grade 3 had a significantly higher 5-year LR rate; the difference was no longer statistically significant at 10 years. (28) In the EORTC trial multivariate analysis at a median follow-up of 10.5 years, intermediately or poorly differentiated DCIS had a significantly increased risk for LR as opposed to well differentiated DCIS (HR = 1.85 and HR = 1.61 respectively). (29) In the updated multivariable analysis performed at 15 years, nuclear grade was not an independent risk factor for local recurrence.…”

Local and Systemic Outcomes in DCIS Based on Tumor and Patient Characteristics: The Radiation Oncologist's Perspective

“…At present, young age per se should not be a contraindication for BCT, especially because it is unknown whether these patients have a superior long-term prognosis if treated by mastectomy. Local recurrences followingboth skin sparing and simple-mastectomy after DCIS are reported and also seem to occur particularly in younger women (12,13).Numerous studies have shown an increased risk of local recurrence when DCIS was excised with doubtful or involved margins (2,6,7,14,15). Various thresholds have been reported as a safe margin status, from "the inked margin not being involved with DCIS," to ≥1, 2, 3, or 5 mm, or even ≥1 cm.…”

“…Age and margin status are the most important factors related to the risk of local recurrence. The impact of young age on the outcome of treatment of DCIS has been studied by several groups (2,(6)(7)(8)(9). In the EORTC 10853 trial, women aged 40 years or younger had a 34% risk of local recurrence at 10 years compared with 19% of the women older than 40 years ( Figure 1).…”

“…Numerous studies have shown an increased risk of local recurrence when DCIS was excised with doubtful or involved margins (2,6,7,14,15). Various thresholds have been reported as a safe margin status, from "the inked margin not being involved with DCIS," to ≥1, 2, 3, or 5 mm, or even ≥1 cm.…”