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

Abstract

RezumatCarcinomul ductal in situ al sânului este un precursor non-invaziv al cancerului mamar şi este reprezentat de un grup de leziuni cu potenţial malign variabil. Tratamentul local optim pentru pacientele cu carcinom ductal in situ rãmane un subiect controversat, în ciuda rezultatelor provenite din mai multe trialuri randomizate. Radioterapia care urmeazã intervenţiei chirurgicale conservatoare reduce aproximativ la jumãtate riscul de recidivã localã, dar nu are impact în ceea ce priveşte supravieţuirea pe termen lung. Studiile clinice desfãşurate pânã în prezent nu au putut identifica un subgrup de paciente cu carcinom ductal in situ cu risc scãzut, la care sã se poata renunţa în siguranţã la radioterapie, dupã intervenţia chirurgicala conservatoare. În lucrare sunt prezentate rezultate ale studiilor clinice în care s-a utilizat chirurgia conservatoare a sânului urmatã sau nu de radioterapie. Alte subiecte abordate se referã la stabilirea indicaţiei terapeutice în cazul carcinomului ductal in situ cu risc scãzut şi la noi tendinţe în radioterapia pentru carcinomul ductal in situ. Review Articlebreast cancerand represents a heterogenous group of lesions with different malignant potential. Despite several randomized trials, there is still controversy regarding the optimal local treatment for DCIS patients. The addition of radiotherapy after breast conserving surgery approximately halves the local recurrence risk but has no impact on long-term survival. Clinical studies failed to identify a low risk subgroup of DCIS patients treated with breast conserving surgery in whom radiotherapy can be safely omitted. Results of clinical trials of breast conserving surgery ± radiotherapy are summarized. Treatment decision making in low risk DCIS and current tendencies in the radiotherapy for DCIS are other issues addressed in this paper.

Is There a Role of Adjuvant Irradiation for Patientswith Ductal Carcinoma in Situ (DCIS) Undergoing Breast Conserving Surgery (BCS)?

“…invasive malignancy without invasion of the basement membran ehistologically, and accounts for approximatelyone-fifth of the total newly diagnosed breast cancersas a rapidly growing subgroup including proliferativelesions with varying malignant potential [1][2][3][4]. Management of DCIS includes several controversies particularly focusing on theutility of irradiation [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Stratification of patients into risk groups in an effort to identify those at a higher risk of local recurrence after surgery is a widely accepted consideration.…”