The impact of adding radiation treatment after breast conservation surgery for ductal carcinoma in situ of the breast

Abstract

Ductal carcinoma in situ (DCIS; intraductal carcinoma) is most commonly detected as suspicious microcalcifications on routine screening mammography in an asymptomatic woman. As most women with newly diagnosed DCIS are eligible for breast conservation treatment, a major decision for most women is whether or not to add radiation treatment after surgical excision (lumpectomy). In four prospective randomized clinical trials, the addition of radiation treatment after lumpectomy reduced the risk of local recurrence by approximately 50%, both for overall local recurrence and for the subset of invasive local recurrence. Nonetheless, efforts have continued to attempt to identify a subset of patients with favorable DCIS who are at sufficiently low risk of local recurrence that omitting radiation treatment is reasonable. Prospective and retrospective studies have demonstrated excellent long-term outcomes at 10 and 15 years after breast conservation treatment with radiation. Careful follow-up, including yearly surveillance mammography, after initial breast conservation treatment with radiation is warranted for the early detection of potentially salvageable local and local-regional recurrences.

Figure 1

Overall survival and cause-specific survival after breast conservation treatment with radiation for 1003 patients with mammographically detected DCIS from a collaborative multi-institutional study. Reprinted from Solin et al. (16), with permission of Wiley.

Figure 2

Local failure according to the final pathology margins from the primary tumor excision after breast conservation treatment with radiation for 1003 patients with mammographically detected DCIS from a collaborative multi-institutional study. Reprinted from Solin et al. (16), with permission of Wiley.

Figure 3

Local failure according to patient age after breast conservation treatment with radiation for 1003 patients with mammographically detected DCIS from a collaborative multi-institutional study. Reprinted from Solin et al. (16), with permission of Wiley.

Figure 4

Local failure according to central pathology review for a subset of 191 patients after breast conservation treatment with radiation from a collaborative multi-institutional study. Reprinted with permission from Solin et al. (17).

Figure 5

Overall survival and cause-specific survival after salvage treatment for 90 patients with local or local-regional recurrence from a collaborative multi-institutional study. At initial presentation of DCIS, all patients had undergone breast conservation treatment with radiation. Reprinted from Solin et al. (29), with permission of Elsevier.

Figure 6

Development of subsequent distant metastatic disease after salvage treatment for patients with local or local-regional recurrence from a collaborative multi-institutional study. At initial presentation of DCIS, all patients had undergone breast conservation treatment with radiation. Reprinted from Solin et al. (29), with permission of Elsevier.