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Published in: Annals of Surgical Oncology 7/2006

01-07-2006

Local Recurrences After Conservative Treatment of Ductal Carcinoma-In-Situ of the Breast Without Radiotherapy: The Effect of Age

Authors: Arjan P. Schouten van der Velden, MD, Petra H. M. Peeters, MD, PhD, Veronica C. M. Koot, MD, PhD, Adriaan Hennipman, MD, PhD

Published in: Annals of Surgical Oncology | Issue 7/2006

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Abstract

Background

The main goal in treatment of ductal carcinoma-in-situ (DCIS) of the breast is to prevent local recurrences. Radiotherapy after breast-conserving surgery has been shown to decrease the recurrence rate, although whether all patients should be treated with radiotherapy remains a topic of debate. The aim of this study was to assess the local recurrence rate after conservative surgical treatment of DCIS without radiotherapy and to identify risk factors for local recurrence.

Methods

A total of 499 female patients with 502 DCIS lesions treated in the period 1989 to 2002 were retrospectively reviewed. Survival rates were calculated by the Kaplan-Meier method, and differences were tested by using the log-rank test. The association of variables with local recurrence was analyzed by using the χ2 test.

Results

Treatment constituted of lumpectomy in 329 patients (65%). Thirty-eight patients (8%) had disease-positive margins, and for 41 patients (8%) the margin status was not known. Eighty tumors recurred, for a local recurrence rate of 13% after 4 years compared with 17% for patients treated with breast-conserving surgery only. Risk factors for ipsilateral recurrences were younger age (<50 years), treatment with breast-conserving surgery only, and presence of disease-involved surgical margins.

Conclusions

Conservative treatment of DCIS results in high recurrences rates, and outcomes can be improved by performing more radical surgery. Because radiotherapy has been shown to be effective in preventing recurrent disease, and, to date, no subgroups have been identified in which radiation can be omitted, its use is recommended, especially in younger patients.
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Literature
1.
go back to reference Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst 2004;96:443–8PubMed Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst 2004;96:443–8PubMed
2.
go back to reference Schwartz GF, Solin LJ, Olivotto IA, Ernster VL, Pressman PI. Consensus conference on the treatment of in situ ductal carcinoma of the breast, April 22-25, 1999. Cancer 2000;15:946–54CrossRef Schwartz GF, Solin LJ, Olivotto IA, Ernster VL, Pressman PI. Consensus conference on the treatment of in situ ductal carcinoma of the breast, April 22-25, 1999. Cancer 2000;15:946–54CrossRef
3.
go back to reference Silverstein MJ, Barth A, Poller DN, et al. Ten-year results comparing mastectomy to excision and radiation therapy for ductal carcinoma in situ of the breast. Eur J Cancer 1995;31A:1425–7PubMedCrossRef Silverstein MJ, Barth A, Poller DN, et al. Ten-year results comparing mastectomy to excision and radiation therapy for ductal carcinoma in situ of the breast. Eur J Cancer 1995;31A:1425–7PubMedCrossRef
4.
go back to reference Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomised trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233–41PubMedCrossRef Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomised trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233–41PubMedCrossRef
5.
go back to reference Morrow M, Strom EA, Bassett LW, et al. Standard for the management of ductal carcinoma in situ of the breast (DCIS). CA Cancer J Clin 2002;52:256–76PubMedCrossRef Morrow M, Strom EA, Bassett LW, et al. Standard for the management of ductal carcinoma in situ of the breast (DCIS). CA Cancer J Clin 2002;52:256–76PubMedCrossRef
6.
go back to reference Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C. Incidence of and treatment for ductal carcinoma of the breast. JAMA 1996;275:913–8PubMedCrossRef Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C. Incidence of and treatment for ductal carcinoma of the breast. JAMA 1996;275:913–8PubMedCrossRef
7.
go back to reference Ottesen GL, Graversen HP, Blichert-Toft M, Christensen IJ, Andersen JA. Carcinoma in situ of the female breast. 10 year follow-up results of a prospective nationwide study. Breast Cancer Res Treat 2000;62:197–210PubMedCrossRef Ottesen GL, Graversen HP, Blichert-Toft M, Christensen IJ, Andersen JA. Carcinoma in situ of the female breast. 10 year follow-up results of a prospective nationwide study. Breast Cancer Res Treat 2000;62:197–210PubMedCrossRef
8.
go back to reference Page DL, Dupont WD, Rogers WL, Jensen RA, Schuyler PA. Continued local recurrence of carcinoma 15-25 years after diagnosis of low grade ductal carcinoma in situ of the breast treated only with biopsy. Cancer 1995;76:1197–200PubMed Page DL, Dupont WD, Rogers WL, Jensen RA, Schuyler PA. Continued local recurrence of carcinoma 15-25 years after diagnosis of low grade ductal carcinoma in situ of the breast treated only with biopsy. Cancer 1995;76:1197–200PubMed
9.
go back to reference Solin LJ, Fourquet A, Vicini FA, et al. Salvage treatment for local recurrence after breast-conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ of the breast. Cancer 2001;91:1090–7PubMedCrossRef Solin LJ, Fourquet A, Vicini FA, et al. Salvage treatment for local recurrence after breast-conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ of the breast. Cancer 2001;91:1090–7PubMedCrossRef
10.
go back to reference Schairer C, Mink PJ, Carroll L, Devesa SS. Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst 2004;96:1311–21PubMedCrossRef Schairer C, Mink PJ, Carroll L, Devesa SS. Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst 2004;96:1311–21PubMedCrossRef
11.
go back to reference Silverstein MJ. The University of Southern California/Van Nuys Prognostic Index for ductal carcinoma in situ of the breast. Am J Surg 2003;186:337–43PubMedCrossRef Silverstein MJ. The University of Southern California/Van Nuys Prognostic Index for ductal carcinoma in situ of the breast. Am J Surg 2003;186:337–43PubMedCrossRef
12.
go back to reference Boyages J, Delaney D, Taylor R. Predictors of local recurrence after treatment of ductal carcinoma in situ. Cancer 1999;85:616–28PubMedCrossRef Boyages J, Delaney D, Taylor R. Predictors of local recurrence after treatment of ductal carcinoma in situ. Cancer 1999;85:616–28PubMedCrossRef
13.
go back to reference Vicini FA, Goldstein NS, Kestin LL. Pathologic and technical considerations in the treatment of ductal carcinoma in situ of the breast with lumpectomy and radiation therapy. Ann Oncol 1999;10:883–90PubMedCrossRef Vicini FA, Goldstein NS, Kestin LL. Pathologic and technical considerations in the treatment of ductal carcinoma in situ of the breast with lumpectomy and radiation therapy. Ann Oncol 1999;10:883–90PubMedCrossRef
14.
go back to reference Waldman F, DeVries S, Chew KL, Moore DH, Kerlikowske K, Ljung B-M. Chromosomal alterations in ductal carcinomas in situ and their in situ recurrences. J Natl Cancer Inst 2000;92:313–20PubMedCrossRef Waldman F, DeVries S, Chew KL, Moore DH, Kerlikowske K, Ljung B-M. Chromosomal alterations in ductal carcinomas in situ and their in situ recurrences. J Natl Cancer Inst 2000;92:313–20PubMedCrossRef
15.
go back to reference Cataliotti L, Distante V, Ciatto S, et al. Intraductal breast cancer: review of 183 consecutive cases. Eur J Cancer 1992:28A:917–20PubMedCrossRef Cataliotti L, Distante V, Ciatto S, et al. Intraductal breast cancer: review of 183 consecutive cases. Eur J Cancer 1992:28A:917–20PubMedCrossRef
16.
go back to reference Fisher B, Costantino J, Redmond C, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med 1993;328:1581–6PubMedCrossRef Fisher B, Costantino J, Redmond C, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med 1993;328:1581–6PubMedCrossRef
17.
go back to reference Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 1998;16:441–52PubMed Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 1998;16:441–52PubMed
18.
go back to reference Fisher ER, Dignam J, Tan-Chiu E, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight year update of protocol B-17. Cancer 1999;86:429–38PubMedCrossRef Fisher ER, Dignam J, Tan-Chiu E, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight year update of protocol B-17. Cancer 1999;86:429–38PubMedCrossRef
19.
go back to reference Julien J-P, Bijker N, Fentiman IS, et al. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. Lancet 2000;355:528–33PubMedCrossRef Julien J-P, Bijker N, Fentiman IS, et al. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. Lancet 2000;355:528–33PubMedCrossRef
20.
go back to reference Bijker N, Peterse JL, Duchateau L, et al. Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853. J Clin Oncol 2001;22:63–71 Bijker N, Peterse JL, Duchateau L, et al. Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853. J Clin Oncol 2001;22:63–71
21.
go back to reference Bijker N, Peterse JL, Fentiman IS, et al. Effects of patient selection on the applicability of results from a randomised clinical trial (EORTC 10853) investigating breast-conserving therapy for DCIS. Br J Cancer 2002;87:615–20PubMedCrossRef Bijker N, Peterse JL, Fentiman IS, et al. Effects of patient selection on the applicability of results from a randomised clinical trial (EORTC 10853) investigating breast-conserving therapy for DCIS. Br J Cancer 2002;87:615–20PubMedCrossRef
22.
go back to reference Silverstein MJ, Gierson ED, Colburn WJ, et al. Can intraductal breast carcinoma be excised completely by local excision? Cancer 1994;73:2985–9PubMed Silverstein MJ, Gierson ED, Colburn WJ, et al. Can intraductal breast carcinoma be excised completely by local excision? Cancer 1994;73:2985–9PubMed
23.
go back to reference Silverstein MJ, Lagios MD, Groshen S, et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 1999;340:1455–61PubMedCrossRef Silverstein MJ, Lagios MD, Groshen S, et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 1999;340:1455–61PubMedCrossRef
24.
go back to reference Chan KC, Knox WF, Sinha G, et al. Extent of excision margin width required in breast conserving surgery for ductal carcinoma in situ. Cancer 2001;91:9–16PubMedCrossRef Chan KC, Knox WF, Sinha G, et al. Extent of excision margin width required in breast conserving surgery for ductal carcinoma in situ. Cancer 2001;91:9–16PubMedCrossRef
25.
go back to reference Kuske RR, Bean JM, Garcia DM, et al. Breast conservation therapy for intraductal carcinoma of the breast. Int J Radiat Oncol Biol Phys 1993;26:391–6PubMed Kuske RR, Bean JM, Garcia DM, et al. Breast conservation therapy for intraductal carcinoma of the breast. Int J Radiat Oncol Biol Phys 1993;26:391–6PubMed
26.
go back to reference Sneige N, McNeese MD, Atkinson EN, et al. Ductal carcinoma in situ treated with lumpectomy and irradiation: histopathological analysis of 49 specimens with emphasis on risk factors and long term results. Hum Pathol 1995;26:642–9PubMedCrossRef Sneige N, McNeese MD, Atkinson EN, et al. Ductal carcinoma in situ treated with lumpectomy and irradiation: histopathological analysis of 49 specimens with emphasis on risk factors and long term results. Hum Pathol 1995;26:642–9PubMedCrossRef
27.
go back to reference Bonnier P, Body G, Bessenay F, et al. Prognostic factors in ductal carcinoma in situ of the breast: results of a retrospective study of 575 cases. Eur J Obstet Gynecol Reprod Biol 1999;84:27–35PubMedCrossRef Bonnier P, Body G, Bessenay F, et al. Prognostic factors in ductal carcinoma in situ of the breast: results of a retrospective study of 575 cases. Eur J Obstet Gynecol Reprod Biol 1999;84:27–35PubMedCrossRef
28.
go back to reference Ringberg A, Idvall I, Ferno M, et al. Ipsilateral local recurrence in relation to therapy and morphological characteristics in patients with ductal carcinoma in situ of the breast. Eur J Surg Oncol 2000;26:444–51PubMedCrossRef Ringberg A, Idvall I, Ferno M, et al. Ipsilateral local recurrence in relation to therapy and morphological characteristics in patients with ductal carcinoma in situ of the breast. Eur J Surg Oncol 2000;26:444–51PubMedCrossRef
29.
go back to reference Rodrigues N, Carter D, Dillon D, Parisot N, Choi DH, Haffty BC. Correlation of clinical and pathologic features with outcome in patients with ductal carcinoma in situ of the breast treated with breast-conserving surgery and radiotherapy. Int J Radiat Oncol Biol Phys 2002;54:1331–5PubMedCrossRef Rodrigues N, Carter D, Dillon D, Parisot N, Choi DH, Haffty BC. Correlation of clinical and pathologic features with outcome in patients with ductal carcinoma in situ of the breast treated with breast-conserving surgery and radiotherapy. Int J Radiat Oncol Biol Phys 2002;54:1331–5PubMedCrossRef
30.
go back to reference Holland R, Hendriks JHCL, Verbeek ALM, Mravunac M, Schuurmans Stekhoven JH. Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ. Lancet 1990;335:519–22PubMedCrossRef Holland R, Hendriks JHCL, Verbeek ALM, Mravunac M, Schuurmans Stekhoven JH. Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ. Lancet 1990;335:519–22PubMedCrossRef
31.
go back to reference Faverly DRG, Burgers L, Bult P, Holland R. Three dimensional imaging of mammary ductal carcinoma in situ: clinical implications. Semin Diagn Pathol 1994;11:193–8PubMed Faverly DRG, Burgers L, Bult P, Holland R. Three dimensional imaging of mammary ductal carcinoma in situ: clinical implications. Semin Diagn Pathol 1994;11:193–8PubMed
32.
go back to reference Mai KT, Yazdi HM, Burn BF, Perkins DG. Pattern of distribution of intraductal and infiltrating carcinoma: a three-dimensional study using serial coronal giant sections of the breast. Hum Pathol 2000;31:464–74PubMedCrossRef Mai KT, Yazdi HM, Burn BF, Perkins DG. Pattern of distribution of intraductal and infiltrating carcinoma: a three-dimensional study using serial coronal giant sections of the breast. Hum Pathol 2000;31:464–74PubMedCrossRef
33.
go back to reference Elkhuizen PHM, Van de Vijver MJ, Hermans J, et al. Local recurrence after breast-conserving therapy for invasive breast cancer: high incidence in young patients and association with poor survival. Int J Radiat Oncol Biol Phys 1998;40:859–67PubMedCrossRef Elkhuizen PHM, Van de Vijver MJ, Hermans J, et al. Local recurrence after breast-conserving therapy for invasive breast cancer: high incidence in young patients and association with poor survival. Int J Radiat Oncol Biol Phys 1998;40:859–67PubMedCrossRef
34.
go back to reference Zee Van KJ, Liberman L, Samli B, et al. Long term follow-up of women with ductal carcinoma in situ treated with breast conserving surgery. Cancer 1999;86:1757–67PubMedCrossRef Zee Van KJ, Liberman L, Samli B, et al. Long term follow-up of women with ductal carcinoma in situ treated with breast conserving surgery. Cancer 1999;86:1757–67PubMedCrossRef
35.
go back to reference Kestin LL, Goldstein NS, Lacerna MD, et al. Factors associated with local recurrence of mammographically detected ductal carcinoma in situ in patients given breast-conserving therapy. Cancer 2000;88:596–607PubMedCrossRef Kestin LL, Goldstein NS, Lacerna MD, et al. Factors associated with local recurrence of mammographically detected ductal carcinoma in situ in patients given breast-conserving therapy. Cancer 2000;88:596–607PubMedCrossRef
36.
go back to reference Kestin LL, Goldstein NS, Martinez AA, et al. Mammographically detected ductal carcinoma in situ treated with conservative surgery with or without radiation therapy. Ann Surg 2000;231:235–45PubMedCrossRef Kestin LL, Goldstein NS, Martinez AA, et al. Mammographically detected ductal carcinoma in situ treated with conservative surgery with or without radiation therapy. Ann Surg 2000;231:235–45PubMedCrossRef
37.
go back to reference Solin LJ, Fourquet A, Vicini FA, et al. Mammographically detected ductal carcinoma in situ of the breast treated with breast-conserving surgery and definitive breast irradiation: long-term outcome and prognostic significance of patient age and margin status. Int J Radiat Oncol Biol Phys 2001;50:991–1002PubMedCrossRef Solin LJ, Fourquet A, Vicini FA, et al. Mammographically detected ductal carcinoma in situ of the breast treated with breast-conserving surgery and definitive breast irradiation: long-term outcome and prognostic significance of patient age and margin status. Int J Radiat Oncol Biol Phys 2001;50:991–1002PubMedCrossRef
38.
go back to reference Cutuli B, Cohen-Solal-Le Nir C, De Lafontan B, et al. Breast conserving therapy for ductal carcinoma in situ of the breast: the French cancer centers’ experience. Int J Radiat Oncol Biol Phys 2002;53:868–79PubMedCrossRef Cutuli B, Cohen-Solal-Le Nir C, De Lafontan B, et al. Breast conserving therapy for ductal carcinoma in situ of the breast: the French cancer centers’ experience. Int J Radiat Oncol Biol Phys 2002;53:868–79PubMedCrossRef
39.
go back to reference Wazer DE, DiPetrillo T, Schmidt-Ullrich R, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 1992;10:356–63PubMed Wazer DE, DiPetrillo T, Schmidt-Ullrich R, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 1992;10:356–63PubMed
40.
go back to reference Vicini FA, Kestin LL, Goldstein NS, Baglan KL, Pattinga JE, Martinez AA. Relationship between excision volume, margin status, and tumor size with the development of local recurrence in patients with ductal carcinoma-in-situ treated with breast-conserving therapy. J Surg Oncol 2001;76:245–54PubMedCrossRef Vicini FA, Kestin LL, Goldstein NS, Baglan KL, Pattinga JE, Martinez AA. Relationship between excision volume, margin status, and tumor size with the development of local recurrence in patients with ductal carcinoma-in-situ treated with breast-conserving therapy. J Surg Oncol 2001;76:245–54PubMedCrossRef
Metadata
Title
Local Recurrences After Conservative Treatment of Ductal Carcinoma-In-Situ of the Breast Without Radiotherapy: The Effect of Age
Authors
Arjan P. Schouten van der Velden, MD
Petra H. M. Peeters, MD, PhD
Veronica C. M. Koot, MD, PhD
Adriaan Hennipman, MD, PhD
Publication date
01-07-2006
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/ASO.2006.05.044

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