Local Recurrences After Different Treatment Strategies for Ductal Carcinoma In Situ of the Breast: A Population-Based Study in the East Netherlands (original) (raw)
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International Journal of Radiation Oncology*Biology*Physics, 2002
Purpose: Although breast-conserving surgery followed by radiotherapy (RT) has become a standard treatment option for patients with ductal carcinoma in situ of the breast, risk factors for ipsilateral breast tumor recurrence (IBTR) in these patients remain an active area of investigation. The purpose of this study was to evaluate the impact of clinical and pathologic features on long-term outcome in a cohort of DCIS patients treated with breast-conserving surgery plus RT. Methods and Materials: Between 1973 and 1998, 230 patients with DCIS were treated with breast-conserving surgery plus RT at our institution. All patients were treated by local excision followed by RT to the breast to a total median tumor bed dose of 64 Gy. Adjuvant hormonal therapy was used in only 20 patients (9%). All available clinical, pathologic, and outcome data, including ipsilateral and contralateral events, were entered into a computerized database. The clinical and pathologic variables evaluated included detection method, mammographic appearance, age, family history, histologic subtype, presence of necrosis, nuclear grade, final margin status, and use of adjuvant hormonal therapy. Results: As of December 15, 2000, with a median follow-up of 8.2 years, 17 patients had developed a recurrence in the ipsilateral breast, resulting in a 5-and 10-year IBTR rate of 5% and 13%, respectively. Contralateral breast cancer developed in 8 patients, resulting in a 10-year contralateral recurrence rate of 5%. Patient age, family history, histologic subtype, margin status, and tumor grade were not significantly associated with recurrence on univariate analysis. A significantly higher rate of local relapse was observed in patients with the presence of necrosis. The 10-year relapse rate was 22% in 88 patients with necrosis compared with 7% in 142 patients without necrosis (p <0.01). In multivariate analysis, the presence of necrosis remained a significant predictor of local relapse. No breast relapses occurred among the 8 patients with positive margins, and three relapses developed among 21 patients with close margins. The rate of IBTR in those with close/positive margins did not differ from the rate in those with negative or unknown margins. It is also notable that none of the 20 patients treated with adjuvant tamoxifen had developed IBTR or a contralateral event to date, although the follow-up on this group was still too short to reach significance. Conclusion: In this cohort of uniformly treated patients with a relatively long follow-up, the presence of necrosis was a significant predictor of local relapse. However, positive or close margin status was not a significant predictor of local relapse. Although none of the patients receiving tamoxifen had a recurrence in the ipsilateral or contralateral breast, longer follow-up is required to assess the effect of tamoxifen on these end points. © 2002 Elsevier Science Inc.
Biologic variables and prognosis in patients with ductal carcinoma in situ of the breast
The Breast, 2001
SUM MAR Y. Ductal carcinoma in situ of the breast is a heterogeneous group of lesions with diverse malignant potential. It is the most rapidly growing subgroup within the breast cancer family with more than 42000 new cases diagnosed in the USA during 2000. Most new cases are nonpalpable and discovered mammographically. Treatment is controversial and ranges from excision only, to excision with radiation therapy, to mastectomy. Prospective randomized trials reveal an approximate 50% reduction in local recurrence rate overall, but the published prospective data do not allow the selection of subgroups in whom the benefit from radiation therapy is so small that its risks outweigh its benefits. Nonrandomized single-facility series suggest that nuclear grade, comedonecrosis, tumour size and margin width are all important factors in predicting local recurrence and that one or more of these factors could be used to select subgroups of patients who do not benefit sufficiently from radiation therapy to merit its use. When conservative treatment fails, approximately 50% of all local recurrences are invasive breast cancer. In spite of this, the mortality rate following invasive local recurrence is relatively low, about 120/0 with 8 years of actuarial follow-up. When all patients with ductal carcinoma in situ are considered, the overall mortality from breast cancer is extremely low, only about 1-2%. Genetic changes routinely precede morphologic evidence of malignant transformation. Medicine must learn how to recognize these genetic changes, exploit them, and in the future, prevent them.
Asian Pacific Journal of Cancer Care
Objectives: The retrospective study evaluated the clinical outcome after treatment of patients diagnosed with ductal carcinoma in situ of breast and reanalyzed the prognostic factors related to recurrence rate and disease free survival(DFS) using long-term follow-up. Material & Methods: Between January 2008 and July 2021, 130 patients previously diagnosed ductal carcinoma in situ underwent surgery. We collected retrospective data characteristic data, radiology data, operative data, pathology data, clinical outcome and time to breast tumor recurrence. Median follow-up time was 51.5 months. Results: The 12-year cumulative incidence of tumor recurrence and re- excision in 130 patients were 6.92%(9 patients) and 12.31%(16 patients). Among 9 patients, 5 patients had locoregional recurrence, 3 patients had distant metastasis recurrence and 1 patient had both. Ki-67(OR, 1.06;95% CI 1.00 – 1.11); p-value = 0.045) was associated with an increase risk of recurrence tumor in multivariable anal...
Current controversies in the treatment of ductal carcinoma in situ of the breast
Ann Ital …, 2008
Ductal carcinoma in situ (DCIS) represents a disease that includes different risk categories and does not necessarily turn into invasive cancer. The 20% of all newly diagnosed breast cancers consist in DCIS, with an incidence increased due to the widespread diffusion of screening programs. Once upon a time, mastectomy was considered the gold standard in treatment of DCIS, but over the years, breastconserving surgery (BCS) has been included as the treatment of choice for patients with small lesions. Several randomized trials demonstrated that adjuvant treatment as radiation and ET reduce the risk of local recurrence, including invasive recurrences. Therefore, in patients with DCIS susceptible to conservative surgery, the key decision for management is represented by the addition of radiotherapy (RT) or ET. With the variety of surgical and adjuvant treatment options available, there has been great interest in tailoring therapies to the individual, with the goal of optimizing the balance of risks and benefits. From the observation of the first data showing how such treatments are not clearly associated with an improvement in disease specific mortality, the upcoming hypothesis is to consider omitting some of such treatments or to plan close surveillance for low risk lesions. Prospective studies on women treated with BCS alone have identified low risk lesions. Actually, the main challenge is how to recognize cases that will not progress to invasive lesions. Despite all the studies carried out and the many available data, there are no unique and universally accepted treatment criteria, so some issues of controversy are still open.
Mastology, 2023
Introduction: With the widespread adoption of mammographic screening for breast cancer, ductal carcinoma in situ (DCIS) has been detected more frequently. In developing countries, the prevalence of ductal carcinoma in situ is low due to the opportunistic nature of breast cancer screening. The aim of this study was to evaluate the clinicopathological characteristics and recurrence rate in a cohort of patients with ductal carcinoma in situ in Brazil. Methods: This study was an retrospective analysis of all 1,736 patients with non-metastatic breast cancer treated at a reference public hospital between 1999 and 2013. All data were collected from medical records and the descriptive statistics were performed to characterize the clinical and pathological features. Results: In the present cohort, we identified 102 (5.2%) patients with non-invasive breast neoplasms. Mean age at diagnosis was 54±12.7 years and most patients were treated with breast conserving surgery. There is a strong association between nuclear grade and the expression of estrogen and progesterone receptors in ductal carcinoma in situ. Ipsilateral and contralateral recurrence rates in 10 years were 7.2% and 2%, respectively. Conclusion: The pathological features of ductal carcinoma in situ diagnosed in Brazil are similar to those observed in patients diagnosed in countries following a systematic screening program, and the treatment in our patients achieves similar success compared with published data in high-income countries.
Management of Ductal Carcinoma in Situ of the Breast: A Clinical Practice Guideline
2006
What is the optimal surgical management of ductal carcinoma in situ (DCIS) of the breast? Should breast irradiation be offered to women with DCIS, following breast-conserving surgery (defined as excision of the tumour with microscopically clear resection margins)? Are there patients who could be spared breast irradiation post-breast-conserving surgery for DCIS? What is the role of tamoxifen in the management of DCIS?
International Journal of Radiation Oncology*Biology*Physics, 2002
Purpose: To assess the long-term outcome for women with ductal carcinoma in situ of the breast treated in current clinical practice by conservative surgery with or without definitive breast irradiation. Methods and Materials: We analyzed 705 cases of ductal carcinoma in situ treated between 1985 and 1995 in nine French regional cancer centers; 515 underwent conservative surgery and radiotherapy (CS؉RT) and 190 CS alone. The median follow-up was 7 years. Results: The 7-year crude local recurrence (LR) rate was 12.6% (95% confidence interval [CI] 9.4 -15.8) and 32.4% (95% CI 25-39.7) for the CS؉RT and CS groups, respectively (p <0.0001). The respective 10-year results were 18.2% (95% CI 13.3-23) and 43.8% (95% CI 30 -57.7). A total of 125 LRs occurred, 66 and 59 in the CS؉RT and CS groups, respectively. Invasive or microinvasive LRs occurred in 60.6% and 52% of the cases in the same respective groups. The median time to LR development was 55 and 41 months. Nine (1.7%) and 6 (3.1%) nodal recurrences occurred in the CS؉RT and CS groups, respectively. Distant metastases occurred in 1.4% and 3% of the respective groups. Patient age and excision quality (final margin status) were both significantly associated with LR risk in the CS؉RT group: the LR rate was 29%, 13%, and 8% among women aged <40, 41-60, and >61 years (p <0.001). Even in the case of complete excision, we observed a 24% rate of LR (6 of 25) in women <40 years. Patients with negative, positive, or uncertain margins had a 7-year crude LR rate of 9.7%, 25.2%, and 12.2%, respectively (p ؍ 0.008). RT reduced the LR rate in all subgroups, especially in those with comedocarcinoma (17% vs. 59% in the CS؉RT and CS groups, respectively, p <0.0001) and mixed cribriform/papillary tumors (9% vs. 31%, p <0.0001). In the multivariate Cox regression model, young age and positive margins remained significant in the CS؉RT group (p ؍ 0.00012 and p ؍ 0.016). Finally, the relative LR risk in the CS؉RT group compared with the CS group was 0.35 (95% CI 0.25-0.51, p ؍ 0.0001). Subsequent contralateral breast cancer occurred in 7.1% and 7.5% of the patients in the CS؉RT and CS groups, respectively. Conclusion: Despite the absence of randomization, our results are extremely consistent with the updated National Surgical Adjuvant Breast Project B17 and European Organization for Research and Treatment of Cancer 10853 trials. We also noted that the LR risk was very high in women <40 years and/or in the case of incomplete excision. © 2002 Elsevier Science Inc.
British journal of cancer, 2004
The grade of recurrent in situ and invasive carcinoma occurring after treatment of pure ductal carcinoma in situ (DCIS) has been compared with the grade of the original DCIS in 122 patients from four different centres (The Royal Marsden Hospitals, London and Sutton, 57 patients; Guy's Hospital, London, 19 patients; Nottingham City Hospital, 31 patients and The Royal Liverpool Hospital, 15 patients). The recurrent carcinoma was pure DCIS in 70 women (57%) and in 52 women (43%) invasive carcinoma was present, which was associated with an in situ element in 43. In all, 19 patients developed a second recurrence (pure DCIS in 11 and invasive with or without an in situ element in eight). The majority of invasive carcinomas followed high-grade DCIS. There was strong agreement between the grade of the original DCIS and that of the recurrent DCIS (kappa=0.679), which was the same in 95 of 113 patients (84%). The grade of the original DCIS showed only fair agreement with the grade of recu...