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Outcome and prognostic factors for local recurrence in mammographically detected ductal carcinoma in-situ of the breast treated with conservative surgery and radiation therapy
146
Radiation Oncology, Biology, Physics
Volume 27, Supplement 1
32 SALVAGE TREATMENT FOR RECURRENCE IN THE BREAST FOLLOWING BREAST-CONSERVING SURGERY AND DEFINITIVE IRRADIATION FOR DUCTAL CARCINOMA IN SITU (INTRADUCTAL CARCINOMA) OF THE BREAST Lawrence J. Solin, Alain Fourquet, Beryl McCormick, Bruce Haffty, Abram Recht, Delray J. Schultz, William Barrett, Barbara Fowble, Robert Kuske, Marie Taylor, Marsha McNeese, Robert Amalric, John Kuttz University of Pennsylvania, lnstitut Curie, Memorial Sloan Kettering Cancer Center, Yale University, Joint Center for Radiation Therapy, University of Cincinnati, Washington University, M.D. Anderson Hospital, University of Basel, Marseille Cancer Institute PURPOSE: The present study was performed to evaluate the outcome of salvage treatment for local recurrence in the breast following breast-conserving surgery and definitive irradiation for ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: An analysis was performed of 274 intraductal breast carcinomas in 272 women. There were two patients with bilateral DCIS at presentation. All tumors were clinical stage Tis NO MO at presentation. All patients had undergone breast-conserving surgery, which included complete gross excision of the primary tumor. Definitive breast radiotherapy was delivered in all cases. Median follow-up time was 8.6 years (range = 0.9-19.7 years). RESULTS: There were 42 (15%) local failures in the breast. The median interval to local failure was 5.1 years (range = 1.4-16.8 years). Five of the 42 local failures occurred more than 10 years after definitive irradiation. The actuarial rate of local recurrence was 7% at 5 years and 16% at 10 years. Of the 42 local recurrences, 23 (55%) showed invasive ductal carcinoma at the time of recurrence, and 19 (45%) showed only intraductal carcinoma, one with associated Paget’s disease. The type of local recurrence was isolated local only first failure in 40 cases, simultaneous local-regional first failure in one case, and simultaneous local-distant first failure in one case. The surgical treatment at the time of local recurrence included mastectomy (n=39) or excision (n=3). Adjuvant systemic therapy at the time of local recurrence included chemotherapy (n=2), hormonal treatment (n=7), or both (n=l). The median follow-up after salvage treatment was 3.7 years (range = 0.1-9.5 years). The survival status at the time of last followup was alive NED (no evidence of disease) in 36 patients (Es%), dead of disease in four patients (IO%), alive with disease in one patient (20/o), and dead NED in one patient (2%). The five-year actuarial outcome following salvage treatment for all 42 local failures showed an overall survival of 78%, a cause-specific survival of 84%, and freedom from distant metastases of 86%. All 5 of the patients that developed distant metastases had a local recurrence that showed invasive carcinoma. None of the 19 local recurrences with intraductal carcinoma developed distant metastases with a median follow-up of 4.7 years (range = 0.2-9.5 years). Thirty-eight of the 42 patients were rendered clinically free of disease with salvage mastectomy with (n=7) or without (n=31) adjuvant systemic therapy. The five-year actuarial outcome following salvage treatment for these 38 patients showed an overall survival of 84%, a cause-specific survival of 90%, and freedom from distant metastases of 91%. CONCLUSIONS: These results demonstrate that local recurrences following definitive breast irradiation for intraductal carcinoma can be salvaged with high rates of survival and freedom from distant metastases. As local recurrences generally are salvageable with further treatment, prolonged follow-up after definitive irradiation for intraductal carcinoma is warranted, particularly as local recurrences can occur ten or more years after treatment.
33 CAN BREAST IRRADIATION BE OMI’lTJZD IN LOW-RISK FIRST RESULTS OF THE ERLANGEN PROTOCOL
BREAST CANCER PATIENTS AFlER SEGMENTECTOMY ?
Rolf Sauer, Augustinus H. Tulusan’, Norbert Lang’, Jiirgen Dunst Department of Radiotherapy and Department of Gynecology and Obstetrics’, University of Erlangen, Germany
Purpose: About 30% of patients with breast preserving surgery benefit from radiotherapy in terms of local control and breast preservation. In two prospective studies, we have addressed the question whether radiotherapy can be omitted in subgroups of patients with well-defined histological low-risk criteria and whether the results of radiation therapy remain good if only high-risk patients with an increased risk for local recurrence are irradiated. Materials and methods: In a preceeding examination of mastectomy specimens, we found that two histological parameters were associated with an increased risk of residual tumor in the remaining breast after segmentectomy with a l-2cm margin: an extensive prospective protocols, we performed intraductal component (EIC) and peritumoral lymphangiosis. In two subsequent segmentectomy in Tl-Ztumors and have classified patients in low vs. high risk for local recurrence depending on EIC and lymphangiosis. In low-risk patients (no lymphangiosis, minimal EIC), radiotherapy was omitted. High-risk patients received adjuvant irradiation (50 Gy to the whole breast, 12 Gy electron boost). The decision to give adjuvant systemic therapy (chemotherapy, hormonal therapy) was independent from local therapy.
Radiation Oncology, Biology, Physics
Volume 27, Supplement 1
32 SALVAGE TREATMENT FOR RECURRENCE IN THE BREAST FOLLOWING BREAST-CONSERVING SURGERY AND DEFINITIVE IRRADIATION FOR DUCTAL CARCINOMA IN SITU (INTRADUCTAL CARCINOMA) OF THE BREAST Lawrence J. Solin, Alain Fourquet, Beryl McCormick, Bruce Haffty, Abram Recht, Delray J. Schultz, William Barrett, Barbara Fowble, Robert Kuske, Marie Taylor, Marsha McNeese, Robert Amalric, John Kuttz University of Pennsylvania, lnstitut Curie, Memorial Sloan Kettering Cancer Center, Yale University, Joint Center for Radiation Therapy, University of Cincinnati, Washington University, M.D. Anderson Hospital, University of Basel, Marseille Cancer Institute PURPOSE: The present study was performed to evaluate the outcome of salvage treatment for local recurrence in the breast following breast-conserving surgery and definitive irradiation for ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: An analysis was performed of 274 intraductal breast carcinomas in 272 women. There were two patients with bilateral DCIS at presentation. All tumors were clinical stage Tis NO MO at presentation. All patients had undergone breast-conserving surgery, which included complete gross excision of the primary tumor. Definitive breast radiotherapy was delivered in all cases. Median follow-up time was 8.6 years (range = 0.9-19.7 years). RESULTS: There were 42 (15%) local failures in the breast. The median interval to local failure was 5.1 years (range = 1.4-16.8 years). Five of the 42 local failures occurred more than 10 years after definitive irradiation. The actuarial rate of local recurrence was 7% at 5 years and 16% at 10 years. Of the 42 local recurrences, 23 (55%) showed invasive ductal carcinoma at the time of recurrence, and 19 (45%) showed only intraductal carcinoma, one with associated Paget’s disease. The type of local recurrence was isolated local only first failure in 40 cases, simultaneous local-regional first failure in one case, and simultaneous local-distant first failure in one case. The surgical treatment at the time of local recurrence included mastectomy (n=39) or excision (n=3). Adjuvant systemic therapy at the time of local recurrence included chemotherapy (n=2), hormonal treatment (n=7), or both (n=l). The median follow-up after salvage treatment was 3.7 years (range = 0.1-9.5 years). The survival status at the time of last followup was alive NED (no evidence of disease) in 36 patients (Es%), dead of disease in four patients (IO%), alive with disease in one patient (20/o), and dead NED in one patient (2%). The five-year actuarial outcome following salvage treatment for all 42 local failures showed an overall survival of 78%, a cause-specific survival of 84%, and freedom from distant metastases of 86%. All 5 of the patients that developed distant metastases had a local recurrence that showed invasive carcinoma. None of the 19 local recurrences with intraductal carcinoma developed distant metastases with a median follow-up of 4.7 years (range = 0.2-9.5 years). Thirty-eight of the 42 patients were rendered clinically free of disease with salvage mastectomy with (n=7) or without (n=31) adjuvant systemic therapy. The five-year actuarial outcome following salvage treatment for these 38 patients showed an overall survival of 84%, a cause-specific survival of 90%, and freedom from distant metastases of 91%. CONCLUSIONS: These results demonstrate that local recurrences following definitive breast irradiation for intraductal carcinoma can be salvaged with high rates of survival and freedom from distant metastases. As local recurrences generally are salvageable with further treatment, prolonged follow-up after definitive irradiation for intraductal carcinoma is warranted, particularly as local recurrences can occur ten or more years after treatment.
33 CAN BREAST IRRADIATION BE OMI’lTJZD IN LOW-RISK FIRST RESULTS OF THE ERLANGEN PROTOCOL
BREAST CANCER PATIENTS AFlER SEGMENTECTOMY ?
Rolf Sauer, Augustinus H. Tulusan’, Norbert Lang’, Jiirgen Dunst Department of Radiotherapy and Department of Gynecology and Obstetrics’, University of Erlangen, Germany
Purpose: About 30% of patients with breast preserving surgery benefit from radiotherapy in terms of local control and breast preservation. In two prospective studies, we have addressed the question whether radiotherapy can be omitted in subgroups of patients with well-defined histological low-risk criteria and whether the results of radiation therapy remain good if only high-risk patients with an increased risk for local recurrence are irradiated. Materials and methods: In a preceeding examination of mastectomy specimens, we found that two histological parameters were associated with an increased risk of residual tumor in the remaining breast after segmentectomy with a l-2cm margin: an extensive prospective protocols, we performed intraductal component (EIC) and peritumoral lymphangiosis. In two subsequent segmentectomy in Tl-Ztumors and have classified patients in low vs. high risk for local recurrence depending on EIC and lymphangiosis. In low-risk patients (no lymphangiosis, minimal EIC), radiotherapy was omitted. High-risk patients received adjuvant irradiation (50 Gy to the whole breast, 12 Gy electron boost). The decision to give adjuvant systemic therapy (chemotherapy, hormonal therapy) was independent from local therapy.