Significance of Multifocality in Ductal Carcinoma In Situ: Outcomes of Women Treated With Breast-Conserving Therapy
There is concern that women with multifocal ductal carcinoma in situ (DCIS; confined to one quadrant) who are treated with breast-conserving surgery face a high risk of local recurrence; therefore, many are treated with mastectomy. The objective of this study is to evaluate the significance of multi...
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| Veröffentlicht in: | Journal of clinical oncology 2007-12, Vol.25 (35), p.5591-5596 |
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| creator | RAKOVITCH, Eileen PIGNOL, Jean-Philippe HANNA, Wedad NAROD, Steven SPAYNE, Jacqueline NOFECH-MOZES, Sharon CHARTIER, Carole PASZAT, Lawrence |
| description | There is concern that women with multifocal ductal carcinoma in situ (DCIS; confined to one quadrant) who are treated with breast-conserving surgery face a high risk of local recurrence; therefore, many are treated with mastectomy. The objective of this study is to evaluate the significance of multifocality and the outcomes of women with multifocal DCIS treated with breast-conserving therapy.
The records of patients treated with breast-conserving surgery for DCIS between 1982 and 2000 were reviewed. Multivariate analyses were performed to evaluate the effects of multifocality and other prognostic factors on the rate of local recurrence.
Of 615 cases of DCIS reviewed, 310 (41%) received breast-conserving surgery and 305 (40%) received breast-conserving surgery plus radiation (n = 260 with multifocality, n = 314 without multifocality, and n = 31 focality unreported). On multivariate analysis, multifocality (hazard ratio [HR] = 1.80; 95% CI, 1.15 to 2.80; P = .01), radiation treatment (HR = 0.46; 95% CI, 0.29 to 0.74; P = .001), margin width 4 mm or smaller (HR = 1.74; 95% CI, 1.03 to 2.92; P = .04), and high nuclear grade (HR = 1.65; 95% CI, 1.02 to 2.65; P = .04) were associated with risk of local recurrence. The detrimental effect of multifocality was limited to women who did not receive radiotherapy; the local recurrence-free survival rate at 10 years was 59% for women with multifocal disease and 80% for women without multifocality (P = .02). Among women treated with breast-conserving surgery plus radiation, there was no difference in 10-year local recurrence-free survival (80% v 87%; P = .35). There was no association between multifocality and the development of invasive recurrence.
Multifocality is a significant predictor of local recurrence in women who receive breast-conserving surgery for DCIS without radiotherapy; however, low recurrence rates can be achieved if adjuvant radiation is administered. |
| doi_str_mv | 10.1200/JCO.2007.11.4686 |
| format | Article |
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The records of patients treated with breast-conserving surgery for DCIS between 1982 and 2000 were reviewed. Multivariate analyses were performed to evaluate the effects of multifocality and other prognostic factors on the rate of local recurrence.
Of 615 cases of DCIS reviewed, 310 (41%) received breast-conserving surgery and 305 (40%) received breast-conserving surgery plus radiation (n = 260 with multifocality, n = 314 without multifocality, and n = 31 focality unreported). On multivariate analysis, multifocality (hazard ratio [HR] = 1.80; 95% CI, 1.15 to 2.80; P = .01), radiation treatment (HR = 0.46; 95% CI, 0.29 to 0.74; P = .001), margin width 4 mm or smaller (HR = 1.74; 95% CI, 1.03 to 2.92; P = .04), and high nuclear grade (HR = 1.65; 95% CI, 1.02 to 2.65; P = .04) were associated with risk of local recurrence. The detrimental effect of multifocality was limited to women who did not receive radiotherapy; the local recurrence-free survival rate at 10 years was 59% for women with multifocal disease and 80% for women without multifocality (P = .02). Among women treated with breast-conserving surgery plus radiation, there was no difference in 10-year local recurrence-free survival (80% v 87%; P = .35). There was no association between multifocality and the development of invasive recurrence.
Multifocality is a significant predictor of local recurrence in women who receive breast-conserving surgery for DCIS without radiotherapy; however, low recurrence rates can be achieved if adjuvant radiation is administered.</description><identifier>ISSN: 0732-183X</identifier><identifier>EISSN: 1527-7755</identifier><identifier>DOI: 10.1200/JCO.2007.11.4686</identifier><identifier>PMID: 17984188</identifier><language>eng</language><publisher>Baltimore, MD: American Society of Clinical Oncology</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Breast Neoplasms - diagnostic imaging ; Breast Neoplasms - radiotherapy ; Breast Neoplasms - surgery ; Carcinoma in Situ - diagnostic imaging ; Carcinoma in Situ - radiotherapy ; Carcinoma in Situ - surgery ; Carcinoma, Ductal, Breast - diagnostic imaging ; Carcinoma, Ductal, Breast - radiotherapy ; Carcinoma, Ductal, Breast - surgery ; Contraindications ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Mammography ; Mastectomy - utilization ; Mastectomy, Segmental ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local - etiology ; Neoplasm Recurrence, Local - prevention & control ; Radiotherapy, Adjuvant ; Treatment Outcome ; Tumors</subject><ispartof>Journal of clinical oncology, 2007-12, Vol.25 (35), p.5591-5596</ispartof><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c401t-446fdd4727a7d53dcdfa333f6244abad3d010783f2c23967e76bb6adb8dfbb03</citedby><cites>FETCH-LOGICAL-c401t-446fdd4727a7d53dcdfa333f6244abad3d010783f2c23967e76bb6adb8dfbb03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3715,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19942755$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17984188$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>RAKOVITCH, Eileen</creatorcontrib><creatorcontrib>PIGNOL, Jean-Philippe</creatorcontrib><creatorcontrib>HANNA, Wedad</creatorcontrib><creatorcontrib>NAROD, Steven</creatorcontrib><creatorcontrib>SPAYNE, Jacqueline</creatorcontrib><creatorcontrib>NOFECH-MOZES, Sharon</creatorcontrib><creatorcontrib>CHARTIER, Carole</creatorcontrib><creatorcontrib>PASZAT, Lawrence</creatorcontrib><title>Significance of Multifocality in Ductal Carcinoma In Situ: Outcomes of Women Treated With Breast-Conserving Therapy</title><title>Journal of clinical oncology</title><addtitle>J Clin Oncol</addtitle><description>There is concern that women with multifocal ductal carcinoma in situ (DCIS; confined to one quadrant) who are treated with breast-conserving surgery face a high risk of local recurrence; therefore, many are treated with mastectomy. The objective of this study is to evaluate the significance of multifocality and the outcomes of women with multifocal DCIS treated with breast-conserving therapy.
The records of patients treated with breast-conserving surgery for DCIS between 1982 and 2000 were reviewed. Multivariate analyses were performed to evaluate the effects of multifocality and other prognostic factors on the rate of local recurrence.
Of 615 cases of DCIS reviewed, 310 (41%) received breast-conserving surgery and 305 (40%) received breast-conserving surgery plus radiation (n = 260 with multifocality, n = 314 without multifocality, and n = 31 focality unreported). On multivariate analysis, multifocality (hazard ratio [HR] = 1.80; 95% CI, 1.15 to 2.80; P = .01), radiation treatment (HR = 0.46; 95% CI, 0.29 to 0.74; P = .001), margin width 4 mm or smaller (HR = 1.74; 95% CI, 1.03 to 2.92; P = .04), and high nuclear grade (HR = 1.65; 95% CI, 1.02 to 2.65; P = .04) were associated with risk of local recurrence. The detrimental effect of multifocality was limited to women who did not receive radiotherapy; the local recurrence-free survival rate at 10 years was 59% for women with multifocal disease and 80% for women without multifocality (P = .02). Among women treated with breast-conserving surgery plus radiation, there was no difference in 10-year local recurrence-free survival (80% v 87%; P = .35). There was no association between multifocality and the development of invasive recurrence.
Multifocality is a significant predictor of local recurrence in women who receive breast-conserving surgery for DCIS without radiotherapy; however, low recurrence rates can be achieved if adjuvant radiation is administered.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Breast Neoplasms - diagnostic imaging</subject><subject>Breast Neoplasms - radiotherapy</subject><subject>Breast Neoplasms - surgery</subject><subject>Carcinoma in Situ - diagnostic imaging</subject><subject>Carcinoma in Situ - radiotherapy</subject><subject>Carcinoma in Situ - surgery</subject><subject>Carcinoma, Ductal, Breast - diagnostic imaging</subject><subject>Carcinoma, Ductal, Breast - radiotherapy</subject><subject>Carcinoma, Ductal, Breast - surgery</subject><subject>Contraindications</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Mammography</subject><subject>Mastectomy - utilization</subject><subject>Mastectomy, Segmental</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Recurrence, Local - etiology</subject><subject>Neoplasm Recurrence, Local - prevention & control</subject><subject>Radiotherapy, Adjuvant</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>0732-183X</issn><issn>1527-7755</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkTuPEzEURi0EYsNCT4XcANUEP8ceOhheixal2EhLZ3n8SLyaGQfbA8q_x1EibXXvlc73FecC8BqjNSYIffjZb9Z1ijXGa9bK9glYYU5EIwTnT8EKCUoaLOnvK_Ai5weEMJOUPwdXWHSSYSlXIN-F3Rx8MHo2DkYPfy1jCT4aPYZyhGGGXxZT9Ah7nUyY46ThzQzvQlk-ws1STJxcPsXu6zLDbXK6OAvvQ9nDz_XIpenjnF36G-Yd3O5d0ofjS_DM6zG7V5d5Dbbfvm77H83t5vtN_-m2MQzh0jDWemuZIEILy6k11mtKqW8JY3rQllqEkZDUE0No1won2mFotR2k9cOA6DV4d649pPhncbmoKWTjxlHPLi5ZtR3iLaWygugMmhRzTs6rQwqTTkeFkTp5VtWzOnlWGKuT5xp5c-lehsnZx8BFbAXeXgCdq0ufqt-QH7muY6Q-qXLvz9w-7Pb_QnIqT3ocay1RDyYSrihXnHeY_gciYZR2</recordid><startdate>20071210</startdate><enddate>20071210</enddate><creator>RAKOVITCH, Eileen</creator><creator>PIGNOL, Jean-Philippe</creator><creator>HANNA, Wedad</creator><creator>NAROD, Steven</creator><creator>SPAYNE, Jacqueline</creator><creator>NOFECH-MOZES, Sharon</creator><creator>CHARTIER, Carole</creator><creator>PASZAT, Lawrence</creator><general>American Society of Clinical Oncology</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20071210</creationdate><title>Significance of Multifocality in Ductal Carcinoma In Situ: Outcomes of Women Treated With Breast-Conserving Therapy</title><author>RAKOVITCH, Eileen ; PIGNOL, Jean-Philippe ; HANNA, Wedad ; NAROD, Steven ; SPAYNE, Jacqueline ; NOFECH-MOZES, Sharon ; CHARTIER, Carole ; PASZAT, Lawrence</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c401t-446fdd4727a7d53dcdfa333f6244abad3d010783f2c23967e76bb6adb8dfbb03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Breast Neoplasms - diagnostic imaging</topic><topic>Breast Neoplasms - radiotherapy</topic><topic>Breast Neoplasms - surgery</topic><topic>Carcinoma in Situ - diagnostic imaging</topic><topic>Carcinoma in Situ - radiotherapy</topic><topic>Carcinoma in Situ - surgery</topic><topic>Carcinoma, Ductal, Breast - diagnostic imaging</topic><topic>Carcinoma, Ductal, Breast - radiotherapy</topic><topic>Carcinoma, Ductal, Breast - surgery</topic><topic>Contraindications</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Mammography</topic><topic>Mastectomy - utilization</topic><topic>Mastectomy, Segmental</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Recurrence, Local - etiology</topic><topic>Neoplasm Recurrence, Local - prevention & control</topic><topic>Radiotherapy, Adjuvant</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>RAKOVITCH, Eileen</creatorcontrib><creatorcontrib>PIGNOL, Jean-Philippe</creatorcontrib><creatorcontrib>HANNA, Wedad</creatorcontrib><creatorcontrib>NAROD, Steven</creatorcontrib><creatorcontrib>SPAYNE, Jacqueline</creatorcontrib><creatorcontrib>NOFECH-MOZES, Sharon</creatorcontrib><creatorcontrib>CHARTIER, Carole</creatorcontrib><creatorcontrib>PASZAT, Lawrence</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>RAKOVITCH, Eileen</au><au>PIGNOL, Jean-Philippe</au><au>HANNA, Wedad</au><au>NAROD, Steven</au><au>SPAYNE, Jacqueline</au><au>NOFECH-MOZES, Sharon</au><au>CHARTIER, Carole</au><au>PASZAT, Lawrence</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Significance of Multifocality in Ductal Carcinoma In Situ: Outcomes of Women Treated With Breast-Conserving Therapy</atitle><jtitle>Journal of clinical oncology</jtitle><addtitle>J Clin Oncol</addtitle><date>2007-12-10</date><risdate>2007</risdate><volume>25</volume><issue>35</issue><spage>5591</spage><epage>5596</epage><pages>5591-5596</pages><issn>0732-183X</issn><eissn>1527-7755</eissn><abstract>There is concern that women with multifocal ductal carcinoma in situ (DCIS; confined to one quadrant) who are treated with breast-conserving surgery face a high risk of local recurrence; therefore, many are treated with mastectomy. The objective of this study is to evaluate the significance of multifocality and the outcomes of women with multifocal DCIS treated with breast-conserving therapy.
The records of patients treated with breast-conserving surgery for DCIS between 1982 and 2000 were reviewed. Multivariate analyses were performed to evaluate the effects of multifocality and other prognostic factors on the rate of local recurrence.
Of 615 cases of DCIS reviewed, 310 (41%) received breast-conserving surgery and 305 (40%) received breast-conserving surgery plus radiation (n = 260 with multifocality, n = 314 without multifocality, and n = 31 focality unreported). On multivariate analysis, multifocality (hazard ratio [HR] = 1.80; 95% CI, 1.15 to 2.80; P = .01), radiation treatment (HR = 0.46; 95% CI, 0.29 to 0.74; P = .001), margin width 4 mm or smaller (HR = 1.74; 95% CI, 1.03 to 2.92; P = .04), and high nuclear grade (HR = 1.65; 95% CI, 1.02 to 2.65; P = .04) were associated with risk of local recurrence. The detrimental effect of multifocality was limited to women who did not receive radiotherapy; the local recurrence-free survival rate at 10 years was 59% for women with multifocal disease and 80% for women without multifocality (P = .02). Among women treated with breast-conserving surgery plus radiation, there was no difference in 10-year local recurrence-free survival (80% v 87%; P = .35). There was no association between multifocality and the development of invasive recurrence.
Multifocality is a significant predictor of local recurrence in women who receive breast-conserving surgery for DCIS without radiotherapy; however, low recurrence rates can be achieved if adjuvant radiation is administered.</abstract><cop>Baltimore, MD</cop><pub>American Society of Clinical Oncology</pub><pmid>17984188</pmid><doi>10.1200/JCO.2007.11.4686</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Breast Neoplasms - diagnostic imaging Breast Neoplasms - radiotherapy Breast Neoplasms - surgery Carcinoma in Situ - diagnostic imaging Carcinoma in Situ - radiotherapy Carcinoma in Situ - surgery Carcinoma, Ductal, Breast - diagnostic imaging Carcinoma, Ductal, Breast - radiotherapy Carcinoma, Ductal, Breast - surgery Contraindications Disease-Free Survival Female Follow-Up Studies Humans Mammography Mastectomy - utilization Mastectomy, Segmental Medical sciences Middle Aged Multivariate Analysis Neoplasm Recurrence, Local - etiology Neoplasm Recurrence, Local - prevention & control Radiotherapy, Adjuvant Treatment Outcome Tumors |
| title | Significance of Multifocality in Ductal Carcinoma In Situ: Outcomes of Women Treated With Breast-Conserving Therapy |
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