Characterization and treatment of local recurrence following breast conservation for ductal carcinoma in situ.

Abstract

PURPOSE:

The optimal treatment strategy for ductal carcinoma in situ (DCIS) continues to evolve and should consider the consequences of initial treatment on the likelihood, type, and treatment of recurrences.

METHODS:

We conducted a retrospective cohort study using two data sources of patients who experienced a recurrence (DCIS or invasive cancer) following breast-conserving surgery (BCS) for index DCIS: patients with an index DCIS diagnosed from 1997 to 2008 at the academic institutions of the National Comprehensive Cancer Network (NCCN; N = 88) and patients with an index DCIS diagnosed from 1990 to 2001 at community-based integrated healthcare delivery sites of the Health Maintenance Organization Cancer Research Network (CRN) (N = 182).

RESULTS:

Just under half of local recurrences in both cohorts were invasive cancer. While 40 % of patients in both cohorts underwent mastectomy alone at recurrence, treatment of the remaining patients varied. In the earlier CRN cohort, most other patients underwent repeat BCS (39 %) with only 18 % receiving mastectomy with reconstruction, whereas only 16 % had repeat BCS and 44 % had mastectomy with reconstruction in the NCCN cohort. Compared with patients not treated with radiation, those who received radiation for index DCIS were less likely to undergo repeat BCS (NCCN: 6.6 vs. 37 %, p = 0.001; CRN: 20 vs. 48 %, p = 0.0004) and more likely to experience surgical complications after treatment of recurrence (NCCN: 15 vs. 4 %, p = 0.17; CRN: 40 vs. 25 %, p = 0.09).

CONCLUSION:

We found that treatment of recurrences after BCS and subsequent complications may be affected by the use of radiotherapy for the index DCIS. Initial treatment of DCIS may have long-term implications that should be considered.

• Authors: Caprice C Greenberg, Laurel A Habel, Melissa E Hughes, Larissa Nekhlyudov, Ninah Achacoso, Luana Acton, Deborah Schrag, Wei Jiang, Stephen Edge, Jane C Weeks, Rinaa S Punglia
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 21 Issue 12 Pg. 3766-73 (Nov 2014) ISSN: 1534-4681 [Electronic] United States
• PMID: 24859938 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, P.H.S.)

Topics

• Adult
• Aged
• Aged, 80 and over
• Breast Neoplasms (pathology, surgery)
• Carcinoma, Ductal, Breast (pathology, surgery)
• Carcinoma, Intraductal, Noninfiltrating (pathology, surgery)
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Humans
• Mastectomy, Segmental (adverse effects)
• Middle Aged
• Neoplasm Invasiveness
• Neoplasm Recurrence, Local (diagnosis, etiology, therapy)
• Neoplasm Staging
• Prognosis
• Radiotherapy Dosage
• Retrospective Studies