Abstract | BACKGROUND: The incidence of ductal carcinoma in situ ( DCIS) has increased markedly in recent decades. In the past, mastectomy was the primary treatment for patients with DCIS, but as with invasive cancer, breast-conserving surgery followed by radiation therapy (RT) has become the standard approach. We present the final results of a multi-institutional retrospective study of an Italian Radiation Oncology Group for the study of conservative treatment of DCIS, characterized by a very long period of accrual, from February 1985 to March 2000, and a median follow-up longer than 11 years. METHODS: A collaborative multi-institutional study was conducted in Italy in 10 Radiation Oncology Departments. A consecutive series of 586 women with DCIS histologically confirmed, treated between February 1985 and March 2000, was retrospectively evaluated. Median age at diagnosis was 55 years (range: 29-84); 32 patients were 40 years old or younger. All women underwent conservative surgery followed by whole breast RT. Irradiation was delivered to the entire breast, for a median total dose of 50 Gy; the tumour bed was boosted in 295 cases (50%) at a median dose of 10 Gy. RESULTS: After a median follow-up of 136 months (range: 16-292 months), 59/586 patients (10%) experienced a local recurrence: invasive in 37 cases, intraductal in 20 and not specified in two. Salvage mastectomy was the treatment of choice in 46 recurrent patients; conservative surgery in 10 and it was unknown in three patients. The incidence of local recurrence was significantly higher in women younger than 40 years (31.3%) (p= 0.0009). Five patients developed distant metastases. Furthermore 40 patients developed a contralateral breast cancer and 31 a second primary tumour in a different site. The 10-year actuarial overall survival (OS) was 95.5% and the 10-year actuarial disease-specific survival (DSS) was 99%. CONCLUSIONS: Our results are consistent with those reported in the literature. In particular it has been defined the importance of young age (40 years or less) as a relevant risk factor for local recurrence. This retrospective multi-institutional Italian study confirms the long term efficacy of breast conserving surgery with RT in women with DCIS.
|
Authors | Cristiana Vidali, Orazio Caffo, Cynthia Aristei, Filippo Bertoni, Alberto Bonetta, Marina Guenzi, Cinzia Iotti, Maria Cristina Leonardi, Salvatore Mussari, Stefano Neri, Nicoletta Pietta |
Journal | Radiation oncology (London, England)
(Radiat Oncol)
Vol. 7
Pg. 177
(Oct 25 2012)
ISSN: 1748-717X [Electronic] England |
PMID | 23098066
(Publication Type: Journal Article, Multicenter Study)
|
Topics |
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms
(mortality, pathology, therapy)
- Carcinoma, Ductal, Breast
(mortality, pathology, therapy)
- Carcinoma, Intraductal, Noninfiltrating
(mortality, pathology, therapy)
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Mastectomy
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Recurrence, Local
(mortality, pathology, therapy)
- Radiotherapy, Adjuvant
- Retrospective Studies
- Survival Rate
- Treatment Outcome
|