Ductal carcinoma in situ (DCIS) treated by mastectomy, or local excision with or without radiotherapy: A monocentric, retrospective study of 608 women. (February 2016)

• Record Type: Journal Article
• Authors: Frank, Sophie; Dupont, Axelle; Teixeira, Luis; Porcher, Raphaël; De Roquancourt, Anne; Giacchetti, Sylvie; Espié, Marc; Cuvier, Caroline
• Is Part Of: Breast. Volume 25(2016)
• Page Start: 51
• Page End: 56
• Publication Date: 2016-02
• Subjects: Ductal carcinoma in situ -- Breast cancer -- Local excision -- Adjuvant radiotherapy -- Local relapse; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2015.10.008
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: Objectives: Since mammographic screening programmes, the proportion of DCIS has dramatically increased. Adjuvant radiotherapy (RT) after local excision (LE) has become a solid option for DCIS since 4 randomised trials have proven a decrease in local relapse (LR), though failing to prove a benefit on mortality rate. DCIS is a heterogeneous disease and it is unclear whether all patients uniformly benefit from radiotherapy. We report a descriptive analysis including all types of treatment. Materials and methods: Our retrospective cohort describes 608 women treated for DCIS in our centre between 1983 and 2013. Mastectomy was recommended before 1992, or for multifocal or >3 cm DCIS. LE alone was an option for DCIS ≤10 mm, with low or intermediate grade, and clear margins (≥2 mm). LE + RT was recommended for all other cases. Results: The median follow-up time was 6.7 years. Treatment consisted in mastectomy for 252 women, LE + RT for 269 and LE for 86. The major prognosis factor for LR rate was the type of treatment: LE + RT or LE was associated with a higher LR-rate than those treated by mastectomy (HR respectively 2.06; 95%CI 1.33–3.19; p = 0.001 and 2.12; 95%CI 1.20–3.65; p = 0.007). In our selected population, women treated by LE + RT versus LE showed no significant differences in LR (HR 0.97; 95%CI 0.61–1.7; p = 0.91). The overall survival rate was 99.7% after ten years, with no differences between the treatment groups. Conclusion: Although retrospective, our monocentric study suggests that LE alone could be an option for DCIS with good prognosis factors. Confirmation by larger randomised studies is needed. Highlights: Descriptive analysis of a monocentric cohort of 608 women treated for DCIS. Local excision alone for DCIS of low/intermediate grade, ≤10 mm, margins ≥2 mm (n = 86). Same local reccurence rate between groups treated by LE + RT and LE alone.