Effect of Margin Status on Local Recurrence After Breast Conservation and Radiation Therapy for Ductal Carcinoma In Situ

2009 ◽  
Vol 27 (10) ◽  
pp. 1615-1620 ◽  
Author(s):  
Clive Dunne ◽  
John P. Burke ◽  
Monica Morrow ◽  
Malcolm R. Kell
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conservation ◽  
Surgical Margin ◽  
Surgical Margins ◽  
Significant Difference

Purpose There is no consensus on what constitutes an adequate surgical margin in patients receiving breast-conserving surgery (BCS) and postoperative radiation therapy (RT) for ductal carcinoma in situ (DCIS). Inadequate margins may result in high local recurrence, and excessively large resections may lead to poor cosmetic outcome without oncologic benefit. Methods A comprehensive search for published trials that examined outcomes after adjuvant RT after BCS for DCIS was performed using MEDLINE and cross referencing available data. Reviews of each study were conducted, and data were extracted. Primary outcome was ipsilateral breast tumor recurrence (IBTR) related to surgical margins. Results A total of 4,660 patients were identified from trials examining BCS and RT for DCIS. Patients with negative margins were significantly less likely to experience recurrence than patients with positive margins after RT (odds ratio [OR] = 0.36; 95% CI, 0.27 to 0.47). A negative margin significantly reduced the risk of IBTR when compared with a close (OR = 0.59; 95% CI, 0.42 to 0.83) or unknown margin (OR = 0.56; 95% CI, 0.36 to 0.87). When specific margin thresholds were examined, a 2-mm margin was superior to a margin less than 2 mm (OR = 0.53; 95% CI, 0.26 to 0.96); however, we saw no significant difference in the rate of IBTR with margins between 2 mm and more than 5 mm (OR = 1.51; 95% CI, 0.51 to 5.0; P > .05). Conclusion Surgical margins negative for DCIS should be obtained after BCS for DCIS. A margin threshold of 2 mm seems to be as good as a larger margin when BCS for DCIS is combined with RT.

scholarly journals Characterization and Treatment of Local Recurrence Following Breast Conservation for Ductal Carcinoma In Situ

2014 ◽  
Vol 21 (12) ◽  
pp. 3766-3773 ◽  
Author(s):  
Caprice C. Greenberg ◽  
Laurel A. Habel ◽  
Melissa E. Hughes ◽  
Larissa Nekhlyudov ◽  
Ninah Achacoso ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conservation

Impact of margin status and re-excision on local control in patients undergoing breast-conservation therapy for ductal carcinoma in situ.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 57-57
Author(s):  
Talha Shaikh ◽  
Tianyu Li ◽  
Fatima Sheikh ◽  
Colin T. Murphy ◽  
Nicholas Zaorsky ◽  
...  
Keyword(s):  
Local Control ◽  
Ductal Carcinoma In Situ ◽  
Hormonal Therapy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conservation ◽  
Breast Conservation Therapy ◽  
Significant Difference ◽  
The Impact

57 Background: The purpose of this study was to identify the impact of final surgical margin (SM) status, SM width, and re-excision on outcomes in patients with ductal carcinoma in situ (DCIS) undergoing breast conservation therapy (BCT). Methods: The study population consisted of women diagnosed with DCIS undergoing BCT between 1989-2014. All women received adjuvant whole breast radiation plus a boost. The primary endpoint was local control (LC) defined as an ipsilateral breast failure. A negative SM was defined as > 2 mm, close SM was defined as > 0 to < 2 mm, and a positive SM was defined as tumor at the inked SM. Cox proportional hazards model was used to determine predictors of outcomes on multivariate analysis (MVA). Actuarial incidence of LC was estimated using the Kaplan-Meier method. Results: A total of 498 patients were included. The median age was 58 (range 30-91) and the median follow-up was 8.3 years (3 months-27 years). A total of 400 patients had a final negative SM, 87 had a close SM, and 11 had a positive SM. A total of 172 patients received adjuvant hormonal therapy, 265 patients required at least one re-excision. Patients with positive or close SMs were more likely to receive a radiation dose > 60 Gy (p < 0.001) and undergo re-excision (p < 0.01). The 10-year LC rates were not significantly different between patients with a negative (93.5%), close (91.8%), or positive (100%) SM (p = 0.57). There was no difference in 10-year LC rates according to a SM width of 0-1 mm (100%), > 1 to 2 mm (88.5%), or > 2 mm (93.5%) (p = 0.85). On univariate analysis, there was no significant difference in LC when comparing negative versus close or positive (p = 1.0) SMs. There was no difference in LC in patients undergoing re-excision for initial close or positive SMs (p = 0.55). On MVA, after controlling for age, dose, hormonal therapy, comedo subtype, and grade, there were no factors associated with LC. Conclusions: This large single-institution experience demonstrates that risks of local failure remain poorly characterized. Re-excision and whole breast radiation plus boost resulted in excellent LC for women with DCIS. Our data suggests that trials aimed at personalized de-intensified local therapy are warranted.

Margin width as the sole determinant of local recurrence after breast conservation in patients with ductal carcinoma in situ of the breast

2006 ◽  
Vol 192 (4) ◽  
pp. 420-422 ◽  
Author(s):  
Heather R. Macdonald ◽  
Melvin J. Silverstein ◽  
Laura A. Lee ◽  
Wei Ye ◽  
Premal Sanghavi ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conservation ◽  
Margin Width

Invasive local recurrence increased after radiation therapy for ductal carcinoma in situ

2008 ◽  
Vol 196 (4) ◽  
pp. 552-555 ◽  
Author(s):  
Lisa E. Guerra ◽  
Robina M. Smith ◽  
Anna Kaminski ◽  
Michael D. Lagios ◽  
Melvin J. Silverstein
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma

The effect of margin status on local recurrence following breast conservation and radiation therapy for DCIS

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 597-597
Author(s):  
M. R. Kell ◽  
C. Dunne ◽  
C. Canning ◽  
M. Morrow
Keyword(s):  
Local Recurrence ◽  
Randomized Trials ◽  
Ductal Carcinoma ◽  
Breast Conservation ◽  
Significant Risk ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Surgical Margins ◽  
Significant Difference

597 Background: There is no consensus on what constitutes an adequate surgical margin in patients receiving breast conserving surgery (BCS) and postoperative irradiation (RT) for ductal carcinoma in situ (DCIS). Inadequate margins may result in high local recurrence, and excessively large resections may lead to poor cosmetic outcome without oncological benefit. Methods: A comprehensive search for published trials which examined outcomes after adjuvant RT following BCS for DCIS was performed using medline and cross referencing available data. Reviews of each study were conducted, and data were extracted. Fixed and random effects methods were used to combine data. Primary outcomes were in breast tumour recurrence (IBTR) related to surgical margins. Results: Analysis of 3,606 patients from randomized trials confirms that patients with negative margins are significantly less likely to recur than those with positive margins after RT (RR 0.53, 95% CI= 0.42 to 0.66, p<0.01). Combined data from randomized and non randomized trials, of 5,500 patients, demonstrates that where the margin status is close or unknown there is significant risk of IBTR compared to a negative margin (RR=1.68, 95% CI= 1.22–2.33, p<0.01). When specific margin thresholds are examined a 2 mm margin is superior to less than 2 mm (OR=0.67, 95% CI 0.51 -0.89, p<0.01), however we saw no significant difference in the rate of IBTR between a 2 mm margin and >5 mm (OR=1.49, 95% CI 0.54 to 4.9, p>0.05). Conclusions: Surgical margins negative for DCIS should be obtained following BCS for DCIS. A margin threshold of 2mm appears be as good as a larger margin when BCS for DCIS is combined with RT. No significant financial relationships to disclose.

Assessing the Benefit of Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma-In-Situ

2005 ◽  
Vol 23 (22) ◽  
pp. 5171-5177 ◽  
Author(s):  
James A. Hayman ◽  
Mohammed U. Kabeto ◽  
Matthew J. Schipper ◽  
Jonathan E. Bennett ◽  
Frank A. Vicini ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Initial Treatment ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Health States ◽  
Similar Reduction

Purpose To assess women's preferences regarding the trade-off between the risks and benefits of treatment with radiation therapy (RT) after breast-conserving surgery (BCS) for ductal carcinoma-in-situ (DCIS). Patients and Methods Utilities were obtained from 120 patients and 210 nonpatients for eight relevant health states using standard gambles. Results Differences in utilities obtained from patient and nonpatient participants between health states were relatively similar. Reduction in the likelihood of local recurrence associated with RT did not result in higher utilities. Utilities for noninvasive recurrence were only lower after initial treatment with RT. Patient and nonpatient participants had the lowest utilities for invasive local recurrence, regardless of initial treatment or manner of salvage therapy. When comparing patient and nonpatient utilities directly, patients had higher utility for being without recurrence after initial RT and lower utility for invasive recurrence salvaged by mastectomy after initial BCS alone. None of the clinical or sociodemographic factors examined explained more than 5% of the variability in the patients' or nonpatients' utilities or their differences. Conclusion The principal benefit associated with adding RT to BCS for DCIS seems to be its ability to reduce invasive recurrences.

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