Ipsilateral Breast Tumor Recurrence After Breast-Conserving Surgery for Ductal Carcinoma in Situ

Purpose Prediction of patients at highest risk for ipsilateral breast tumor recurrence (IBTR) after local excision of ductal carcinoma in situ (DCIS) remains a clinical concern. The aim of our study was to evaluate a published nomogram from Memorial Sloan-Kettering Cancer Center to predict for risk of IBTR in patients with DCIS from our institution. Patients and Methods We retrospectively identified 794 patients with a diagnosis of DCIS who had undergone local excision from 1990 through 2007 at the MD Anderson Cancer Center (MDACC). Clinicopathologic factors and the performance of the Memorial Sloan-Kettering Cancer Center nomogram for prediction of IBTR were assessed for 734 patients who had complete data. Results There was a marked difference with respect to tumor grade, prevalence of necrosis, initial presentation, final margins, and receipt of endocrine therapy between the two cohorts. The biggest difference was that more patients received radiation in the MDACC cohort (75% at MDACC v 49% at MSKCC; P < .001). Follow-up time in the MDACC cohort was longer than in the MSKCC cohort (median 7.1 years v 5.6 years), and the recurrence rate was lower in the MDACC cohort (7.9% v 11%). The median 5-year probability of recurrence was 5%, and the median 10-year probability of recurrence was 7%. The nomogram for prediction of 5- and 10-year IBTR probabilities demonstrated imperfect calibration and discrimination, with a concordance index of 0.63. Conclusion Predictive models for IBTR in patients with DCIS who were treated with local excision are imperfect. Our current ability to accurately predict recurrence on the basis of clinical parameters alone is limited.

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Rates of ipsilateral breast tumour recurrence (IBTR) following breast conserving surgery (BCS) and hypofractionated radiotherapy for ductal carcinoma in situ (DCIS)

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2016.02.139 ◽

2016 ◽

Vol 42 (5) ◽

pp. S35

Author(s):

Dorin Dumitru ◽

Gordon Wishart ◽

Elena Provenzano ◽

John Benson

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Conserving Surgery ◽

Breast Tumour ◽

Tumour Recurrence ◽

Hypofractionated Radiotherapy ◽

Ipsilateral Breast ◽

Ipsilateral Breast Tumour Recurrence

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Outcome after Mastectomy for Ipsilateral Breast Tumor Recurrence after Breast Conserving Surgery

The American Surgeon ◽

10.1177/000313481007600826 ◽

2010 ◽

Vol 76 (8) ◽

pp. 829-834 ◽

Cited By ~ 6

Author(s):

H. Randall Beard ◽

Emily F. Cantrell ◽

Gregory B. Russell ◽

Marissa Howard-Mcnatt ◽

Perry Shen ◽

...

Keyword(s):

Breast Tumor ◽

Tumor Recurrence ◽

Ductal Carcinoma ◽

Ipsilateral Breast Tumor Recurrence ◽

Breast Conserving Surgery ◽

Breast Cancer Patients ◽

Ipsilateral Breast ◽

Increased Risk ◽

Group A

Ipsilateral breast tumor recurrence (IBTR) is a risk after breast conserving surgery, and is traditionally treated with mastectomy. Given the limited literature on outcome after mastectomy for IBTR, we evaluated our long-term data for this group. A retrospective review was conducted using a database of 2101 breast cancer patients at a single institution. Fifty-nine patients underwent breast conserving surgery and experienced an IBTR. Exclusion criteria included repeat lumpectomy or metastatic disease before mastectomy. Patients presented with invasive ductal (58%), invasive lobular (7%), other invasive (11%), or ductal carcinoma in situ (24%). Initial tumors were Tis (24%), T1 (42%), T2 (20%), T3 (2%), or not recorded (12%). IBTR lesions were Tis (20%), T1 (46%), T2 (25%), or T3 (9%). Median follow-up after mastectomy was 4.6 years. Thirteen patients (22%) had post-mastectomy recurrence (PMR), which decreased overall survival ( P = 0.002). PMR was more common with larger IBTR tumors ( P = 0.03), specifically IBTR ≥ T2 ( P = 0.003). Eighty-five per cent of PMR occurred within 2 years of mastectomy. Mastectomy for IBTR remains effective treatment for most patients, but the risk of PMR remains. Patients with IBTR tumors >2 cm have an increased risk of PMR. Strict follow-up should be routine, especially during the first 24 months.

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Long-term risk of subsequent ipsilateral lesions after surgery with or without radiotherapy for ductal carcinoma in situ of the breast

British Journal of Cancer ◽

10.1038/s41416-021-01496-6 ◽

2021 ◽

Author(s):

Maartje van Seijen ◽

Esther H. Lips ◽

Liping Fu ◽

Daniele Giardiello ◽

Frederieke van Duijnhoven ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Cumulative Incidence ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Conserving Surgery ◽

Ipsilateral Breast ◽

Cox Models ◽

Dcis Treatment ◽

The Impact

Abstract Background Radiotherapy (RT) following breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) reduces ipsilateral breast event rates in clinical trials. This study assessed the impact of DCIS treatment on a 20-year risk of ipsilateral DCIS (iDCIS) and ipsilateral invasive breast cancer (iIBC) in a population-based cohort. Methods The cohort comprised all women diagnosed with DCIS in the Netherlands during 1989–2004 with follow-up until 2017. Cumulative incidence of iDCIS and iIBC following BCS and BCS + RT were assessed. Associations of DCIS treatment with iDCIS and iIBC risk were estimated in multivariable Cox models. Results The 20-year cumulative incidence of any ipsilateral breast event was 30.6% (95% confidence interval (CI): 28.9–32.6) after BCS compared to 18.2% (95% CI 16.3–20.3) following BCS + RT. Women treated with BCS compared to BCS + RT had higher risk of developing iDCIS and iIBC within 5 years after DCIS diagnosis (for iDCIS: hazard ratio (HR)age < 50 3.2 (95% CI 1.6–6.6); HRage ≥ 50 3.6 (95% CI 2.6–4.8) and for iIBC: HRage<50 2.1 (95% CI 1.4–3.2); HRage ≥ 50 4.3 (95% CI 3.0–6.0)). After 10 years, the risk of iDCIS and iIBC no longer differed for BCS versus BCS + RT (for iDCIS: HRage < 50 0.7 (95% CI 0.3–1.5); HRage ≥ 50 0.7 (95% CI 0.4–1.3) and for iIBC: HRage < 50 0.6 (95% CI 0.4–0.9); HRage ≥ 50 1.2 (95% CI 0.9–1.6)). Conclusion RT is associated with lower iDCIS and iIBC risk up to 10 years after BCS, but this effect wanes thereafter.

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