The conservative management of Paget's disease of the breast with radiotherapy.

Abstract

BACKGROUND:

The purpose of this study was to evaluate the feasibility of breast-conserving therapy involving limited surgery and definitive radiotherapy as a treatment for Paget's disease, and to determine the disease free and overall survival associated with this approach.

METHODS:

The authors retrospectively reviewed the charts of all patients treated during the period 1980-1994 for Paget's disease of the breast who did not present with a palpable mass or mammographic density. Through a collaborative review, 30 cases were identified. A biopsy confirming the presence of typical Paget's cells was performed on all patients. All patients received external beam radiotherapy to the breast, with a median dose of 50 gray (Gy). Ninety-seven percent received a boost to the remaining nipple or tumor bed, with a median dose to the tumor bed of 61.5 Gy.

RESULTS:

The median follow-up for surviving patients was 62 months. Three patients (10%) developed a recurrence in the breast as the only site of first failure, and 2 additional patients (7%) experienced failure in the breast as a component of first failure. The median time to local failure was 69 months. The 5- and 8-year actuarial estimates of local failure as the only site of first failure were 9% (95% confidence interval [CI], 0-20%) and 16% (95% CI, 0-31%), respectively. Of the 5 patients with local failures, 3 were among 22 patients (14%) who underwent complete resection of the nipple or nipple-areola complex, compared with 2 failures among 6 patients (33%) after partial resection (P = 0.29). There were no failures among 2 patients who had a biopsy only. Four of 5 local failures were salvaged by mastectomy, and 3 of these patients were free of disease after a median follow-up of 52 months. The 5- and 8-year estimates of disease free survival for the overall series were both 95% (95% CI, 87-100%); cause specific overall survival was 100% at 8 years.

CONCLUSIONS:

Breast-conserving therapy involving complete resection of the nipple-areola complex followed by definitive radiotherapy is a viable alternative to mastectomy in the treatment of Paget's disease. High rates of disease free and cause specific survival, in addition to adequate local control, justify consideration of a conservative approach.

• Authors: L J Pierce, B G Haffty, L J Solin, B McCormick, F A Vicini, D E Wazer, A Recht, M Strawderman, A S Lichter
• Journal: Cancer (Cancer) Vol. 80 Issue 6 Pg. 1065-72 (Sep 15 1997) ISSN: 0008-543X [Print] United States
• PMID: 9305706 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Disease-Free Survival
• Feasibility Studies
• Female
• Humans
• Middle Aged
• Neoplasm Recurrence, Local
• Paget's Disease, Mammary (radiotherapy, surgery)
• Radiotherapy Dosage
• Radiotherapy, Adjuvant
• Retrospective Studies
• Survival Analysis
• Treatment Outcome