The impact of adding radiation treatment after breast conservation surgery for ductal carcinoma in situ of the breast.
ABSTRACT Ductal carcinoma in situ (DCIS; intraductal carcinoma) is most commonly detected as suspicious microcalcifications on routine screening mammography in an asymptomatic woman. As most women with newly diagnosed DCIS are eligible for breast conservation treatment, a major decision for most women is whether or not to add radiation treatment after surgical excision (lumpectomy). In four prospective randomized clinical trials, the addition of radiation treatment after lumpectomy reduced the risk of local recurrence by approximately 50%, both for overall local recurrence and for the subset of invasive local recurrence. Nonetheless, efforts have continued to attempt to identify a subset of patients with favorable DCIS who are at sufficiently low risk of local recurrence that omitting radiation treatment is reasonable. Prospective and retrospective studies have demonstrated excellent long-term outcomes at 10 and 15 years after breast conservation treatment with radiation. Careful follow-up, including yearly surveillance mammography, after initial breast conservation treatment with radiation is warranted for the early detection of potentially salvageable local and local-regional recurrences.
Gynécologie Obstétrique & Fertilité 06/2012; 40(6):387–389. DOI:10.1016/j.gyobfe.2012.04.004 · 0.58 Impact Factor
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ABSTRACT: To complement and update the 2007 practice guidelines of the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO) for radiotherapy (RT) of breast cancer. Owing to its growing clinical relevance, in the current version, a separate paper is dedicated to non-invasive proliferating epithelial neoplasia of the breast. In addition to the more general statements of the German interdisciplinary S3 guidelines, this paper is especially focused on indication and technique of RT in addition to breast conserving surgery. The DEGRO expert panel performed a comprehensive survey of the literature comprising recently published data from clinical controlled trials, systematic reviews as well as meta-analyses, referring to the criteria of evidence-based medicine yielding new aspects compared to 2005 and 2007. The literature search encompassed the period 2008 to September 2012 using databases of PubMed and Guidelines International Network (G-I-N). Search terms were "non invasive breast cancer", "ductal carcinoma in situ, "dcis", "borderline breast lesions", "lobular neoplasia", "radiotherapy" and "radiation therapy". In addition to the more general statements of the German interdisciplinary S3 guidelines, this paper is especially focused on indications of RT and decision making of non-invasive neoplasia of the breast after surgery, especially ductal carcinoma in situ. Among different non-invasive neoplasia of the breast only the subgroup of pure ductal carcinoma in situ (DCIS; synonym ductal intraepithelial neoplasia, DIN) is considered for further recurrence risk reduction treatment modalities after complete excision of DCIS, particularly RT following breast conserving surgery (BCS), in order to avoid a mastectomy. About half of recurrences are invasive cancers. Up to 50 % of all recurrences require salvage mastectomy. Randomized clinical trials and a huge number of mostly observational studies have unanimously demonstrated that RT significantly reduces recurrence risks of ipsilateral DCIS as well as invasive breast cancer independent of patient age in all subgroups. The recommended total dose is 50 Gy administered as whole breast irradiation (WBI) in single fractions of 1.8 or 2.0 Gy given on 5 days weekly. Retrospective data indicate a possible beneficial effect of an additional tumor bed boost for younger patients. Prospective clinical trials of different dose-volume concepts (hypofractionation, accelerated partial breast irradiation, boost radiotherapy) are still ongoing. Postoperative radiotherapy permits breast conservation for the majority of women by halving local recurrence as well as reducing progression rates into invasive cancer. New data confirmed this effect in all patient subsets-even in low risk subgroups (LoE 1a).Strahlentherapie und Onkologie 12/2013; 190(1). DOI:10.1007/s00066-013-0502-3 · 2.73 Impact Factor
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ABSTRACT: This study was performed to determine the risk of tumor recurrence after local excision alone in patients with small size (≤1 cm) ductal carcinoma in situ (DCIS) of the breast. We have treated 107 patients who had DCIS measuring ≤1 cm with margin widths of ≥0.3 cm with excision alone per institutional protocol. With a median follow-up time of 58 months, 4 patients developed ipsilateral breast tumor recurrence (IBTR). Two of the 4 recurrences were invasive, whereas 2 were DCIS. The 5-year rate of IBTR was 6.1%. The patients with resection margin of <1.0 cm had significantly higher rate of IBTR than the patients with resection margin of ≥1.0 cm (23.1% vs. 1.5% at 5-year, p < 0.01). In conclusion, radiotherapy is necessary in the patients with resection margin of <1.0 cm after excision alone because of the substantial risk of IBTR.Breast (Edinburgh, Scotland) 06/2014; 23(5). DOI:10.1016/j.breast.2014.05.025 · 2.09 Impact Factor