Clinical Outcome after Selective Treatment of Patients Diagnosed with Ductal Carcinoma In Situ of the Breast
Background The effect of treatment of patients diagnosed with ductal carcinoma in situ (DCIS) of the breast was evaluated, and factors associated with local recurrence were assessed. Methods The study involved 504 patients treated by means of wide local excision alone (WLE) ( n = 91), wide local ex...
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| Veröffentlicht in: | Annals of surgical oncology 2008, Vol.15 (1), p.235-243 |
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| creator | Meijnen, Philip Oldenburg, Hester S. A. Peterse, Johannes L. Bartelink, Harry Rutgers, Emiel J. Th |
| description | Background
The effect of treatment of patients diagnosed with ductal carcinoma in situ (DCIS) of the breast was evaluated, and factors associated with local recurrence were assessed.
Methods
The study involved 504 patients treated by means of wide local excision alone (WLE) (
n
= 91), wide local excision and radiotherapy (WLE+RT) (
n
= 119), or mastectomy (
n
= 294) at the Netherlands Cancer Institute between 1986 and 2005. Clinical, pathological, and follow-up data were evaluated.
Results
The median time to follow-up was 6.7 years. The 8-year overall local recurrence rate was 12% after breast-conserving treatment (BCT) [15.6% after WLE and 8.8% after WLE+RT (
P
= 0.161)] and 0.9% after mastectomy (
P
|
| doi_str_mv | 10.1245/s10434-007-9659-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70195790</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1415632691</sourcerecordid><originalsourceid>FETCH-LOGICAL-c369t-ff77c60a7fe2be8972704f4022063d49ed9e4a9a688b6144fcd3e65d79853b483</originalsourceid><addsrcrecordid>eNp1kU1LXDEUhkOp1Kn6A9xI6KK7W_Odm2U7tnVAUFDXIZN7Mkbuh01yLf57M8zAQKGrHJL3fU7OeRE6p-QbZUJeZkoEFw0hujFKmoZ9QAsq641QLf1Ya6LaxjAlj9HnnJ8JoZoT-QkdU21azQVboH7ZxzF61-PbufhpAOxCgYTvoQdf4ivghwSuDDAWPAV850qsZcZX0W3GKUOH_8byhK9mXypj6ZKP4zQ4vBrxfSzz1lOeAP-okFxO0VFwfYaz_XmCHn_9fFheNze3v1fL7zeN58qUJgStvSJOB2BraI1mmoggCGNE8U4Y6AwIZ5xq27WiQgTfcVCyq0NJvhYtP0Ffd9yXNP2ZIRc7xOyh790I05ytJtRIbUgVfvlH-DzNaax_s4xpLqmiWxrdiXyack4Q7EuKg0tvlhK7zcHucrA1B7vNwbLqudiD5_UA3cGxX3wVsJ0g16dxA-nQ-f_Ud2KIkns</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>227351618</pqid></control><display><type>article</type><title>Clinical Outcome after Selective Treatment of Patients Diagnosed with Ductal Carcinoma In Situ of the Breast</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Meijnen, Philip ; Oldenburg, Hester S. A. ; Peterse, Johannes L. ; Bartelink, Harry ; Rutgers, Emiel J. Th</creator><creatorcontrib>Meijnen, Philip ; Oldenburg, Hester S. A. ; Peterse, Johannes L. ; Bartelink, Harry ; Rutgers, Emiel J. Th</creatorcontrib><description>Background
The effect of treatment of patients diagnosed with ductal carcinoma in situ (DCIS) of the breast was evaluated, and factors associated with local recurrence were assessed.
Methods
The study involved 504 patients treated by means of wide local excision alone (WLE) (
n
= 91), wide local excision and radiotherapy (WLE+RT) (
n
= 119), or mastectomy (
n
= 294) at the Netherlands Cancer Institute between 1986 and 2005. Clinical, pathological, and follow-up data were evaluated.
Results
The median time to follow-up was 6.7 years. The 8-year overall local recurrence rate was 12% after breast-conserving treatment (BCT) [15.6% after WLE and 8.8% after WLE+RT (
P
= 0.161)] and 0.9% after mastectomy (
P
< 0.0001). In total, 18 (66.7%) invasive local recurrences and 9 (33.3%) DCIS local recurrences occurred. The 8-year distant metastasis rate was 4% after BCT [4.3% after WLE and 4.2% after WLE+RT (
P
= 0.983)] and 0.9% after mastectomy (
P
= 0.048). Median tumor extent was 10, 15, and 35 mm for patients treated with WLE, WLE+RT, and mastectomy, respectively. Margins were involved in 6.4% of all patients. Factors associated with local recurrence were age younger than 40 years (HR 8.66), surgical margin involvement (HR 5.75), WLE (HR 26.77), and WLE+RT (HR 7.42).
Conclusion
BCT of DCIS bears the risk of residual disease progressing into invasive local recurrence and distant metastasis. A re-excision or mastectomy is therefore desired in all patients with unclear margins. Mastectomy treatment is associated with optimal local control and might be considered for patients younger than 40 years who are at high risk of local recurrence.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-007-9659-2</identifier><identifier>PMID: 17987342</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms - radiotherapy ; Breast Neoplasms - surgery ; Breast Neoplasms - therapy ; Breast Oncology ; Carcinoma, Intraductal, Noninfiltrating - radiotherapy ; Carcinoma, Intraductal, Noninfiltrating - surgery ; Carcinoma, Intraductal, Noninfiltrating - therapy ; Clinical outcomes ; Combined Modality Therapy ; Female ; Humans ; Mastectomy, Segmental ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local - pathology ; Oncology ; Surgery ; Surgical Oncology ; Survival Rate ; Treatment Outcome</subject><ispartof>Annals of surgical oncology, 2008, Vol.15 (1), p.235-243</ispartof><rights>Society of Surgical Oncology 2007</rights><rights>Society of Surgical Oncology 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c369t-ff77c60a7fe2be8972704f4022063d49ed9e4a9a688b6144fcd3e65d79853b483</citedby><cites>FETCH-LOGICAL-c369t-ff77c60a7fe2be8972704f4022063d49ed9e4a9a688b6144fcd3e65d79853b483</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-007-9659-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-007-9659-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17987342$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meijnen, Philip</creatorcontrib><creatorcontrib>Oldenburg, Hester S. A.</creatorcontrib><creatorcontrib>Peterse, Johannes L.</creatorcontrib><creatorcontrib>Bartelink, Harry</creatorcontrib><creatorcontrib>Rutgers, Emiel J. Th</creatorcontrib><title>Clinical Outcome after Selective Treatment of Patients Diagnosed with Ductal Carcinoma In Situ of the Breast</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
The effect of treatment of patients diagnosed with ductal carcinoma in situ (DCIS) of the breast was evaluated, and factors associated with local recurrence were assessed.
Methods
The study involved 504 patients treated by means of wide local excision alone (WLE) (
n
= 91), wide local excision and radiotherapy (WLE+RT) (
n
= 119), or mastectomy (
n
= 294) at the Netherlands Cancer Institute between 1986 and 2005. Clinical, pathological, and follow-up data were evaluated.
Results
The median time to follow-up was 6.7 years. The 8-year overall local recurrence rate was 12% after breast-conserving treatment (BCT) [15.6% after WLE and 8.8% after WLE+RT (
P
= 0.161)] and 0.9% after mastectomy (
P
< 0.0001). In total, 18 (66.7%) invasive local recurrences and 9 (33.3%) DCIS local recurrences occurred. The 8-year distant metastasis rate was 4% after BCT [4.3% after WLE and 4.2% after WLE+RT (
P
= 0.983)] and 0.9% after mastectomy (
P
= 0.048). Median tumor extent was 10, 15, and 35 mm for patients treated with WLE, WLE+RT, and mastectomy, respectively. Margins were involved in 6.4% of all patients. Factors associated with local recurrence were age younger than 40 years (HR 8.66), surgical margin involvement (HR 5.75), WLE (HR 26.77), and WLE+RT (HR 7.42).
Conclusion
BCT of DCIS bears the risk of residual disease progressing into invasive local recurrence and distant metastasis. A re-excision or mastectomy is therefore desired in all patients with unclear margins. Mastectomy treatment is associated with optimal local control and might be considered for patients younger than 40 years who are at high risk of local recurrence.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Breast Neoplasms - radiotherapy</subject><subject>Breast Neoplasms - surgery</subject><subject>Breast Neoplasms - therapy</subject><subject>Breast Oncology</subject><subject>Carcinoma, Intraductal, Noninfiltrating - radiotherapy</subject><subject>Carcinoma, Intraductal, Noninfiltrating - surgery</subject><subject>Carcinoma, Intraductal, Noninfiltrating - therapy</subject><subject>Clinical outcomes</subject><subject>Combined Modality Therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Mastectomy, Segmental</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Oncology</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kU1LXDEUhkOp1Kn6A9xI6KK7W_Odm2U7tnVAUFDXIZN7Mkbuh01yLf57M8zAQKGrHJL3fU7OeRE6p-QbZUJeZkoEFw0hujFKmoZ9QAsq641QLf1Ya6LaxjAlj9HnnJ8JoZoT-QkdU21azQVboH7ZxzF61-PbufhpAOxCgYTvoQdf4ivghwSuDDAWPAV850qsZcZX0W3GKUOH_8byhK9mXypj6ZKP4zQ4vBrxfSzz1lOeAP-okFxO0VFwfYaz_XmCHn_9fFheNze3v1fL7zeN58qUJgStvSJOB2BraI1mmoggCGNE8U4Y6AwIZ5xq27WiQgTfcVCyq0NJvhYtP0Ffd9yXNP2ZIRc7xOyh790I05ytJtRIbUgVfvlH-DzNaax_s4xpLqmiWxrdiXyack4Q7EuKg0tvlhK7zcHucrA1B7vNwbLqudiD5_UA3cGxX3wVsJ0g16dxA-nQ-f_Ud2KIkns</recordid><startdate>2008</startdate><enddate>2008</enddate><creator>Meijnen, Philip</creator><creator>Oldenburg, Hester S. A.</creator><creator>Peterse, Johannes L.</creator><creator>Bartelink, Harry</creator><creator>Rutgers, Emiel J. Th</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><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>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>2008</creationdate><title>Clinical Outcome after Selective Treatment of Patients Diagnosed with Ductal Carcinoma In Situ of the Breast</title><author>Meijnen, Philip ; Oldenburg, Hester S. A. ; Peterse, Johannes L. ; Bartelink, Harry ; Rutgers, Emiel J. Th</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c369t-ff77c60a7fe2be8972704f4022063d49ed9e4a9a688b6144fcd3e65d79853b483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Breast Neoplasms - radiotherapy</topic><topic>Breast Neoplasms - surgery</topic><topic>Breast Neoplasms - therapy</topic><topic>Breast Oncology</topic><topic>Carcinoma, Intraductal, Noninfiltrating - radiotherapy</topic><topic>Carcinoma, Intraductal, Noninfiltrating - surgery</topic><topic>Carcinoma, Intraductal, Noninfiltrating - therapy</topic><topic>Clinical outcomes</topic><topic>Combined Modality Therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Mastectomy, Segmental</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Oncology</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Meijnen, Philip</creatorcontrib><creatorcontrib>Oldenburg, Hester S. A.</creatorcontrib><creatorcontrib>Peterse, Johannes L.</creatorcontrib><creatorcontrib>Bartelink, Harry</creatorcontrib><creatorcontrib>Rutgers, Emiel J. Th</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Meijnen, Philip</au><au>Oldenburg, Hester S. A.</au><au>Peterse, Johannes L.</au><au>Bartelink, Harry</au><au>Rutgers, Emiel J. Th</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Outcome after Selective Treatment of Patients Diagnosed with Ductal Carcinoma In Situ of the Breast</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2008</date><risdate>2008</risdate><volume>15</volume><issue>1</issue><spage>235</spage><epage>243</epage><pages>235-243</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
The effect of treatment of patients diagnosed with ductal carcinoma in situ (DCIS) of the breast was evaluated, and factors associated with local recurrence were assessed.
Methods
The study involved 504 patients treated by means of wide local excision alone (WLE) (
n
= 91), wide local excision and radiotherapy (WLE+RT) (
n
= 119), or mastectomy (
n
= 294) at the Netherlands Cancer Institute between 1986 and 2005. Clinical, pathological, and follow-up data were evaluated.
Results
The median time to follow-up was 6.7 years. The 8-year overall local recurrence rate was 12% after breast-conserving treatment (BCT) [15.6% after WLE and 8.8% after WLE+RT (
P
= 0.161)] and 0.9% after mastectomy (
P
< 0.0001). In total, 18 (66.7%) invasive local recurrences and 9 (33.3%) DCIS local recurrences occurred. The 8-year distant metastasis rate was 4% after BCT [4.3% after WLE and 4.2% after WLE+RT (
P
= 0.983)] and 0.9% after mastectomy (
P
= 0.048). Median tumor extent was 10, 15, and 35 mm for patients treated with WLE, WLE+RT, and mastectomy, respectively. Margins were involved in 6.4% of all patients. Factors associated with local recurrence were age younger than 40 years (HR 8.66), surgical margin involvement (HR 5.75), WLE (HR 26.77), and WLE+RT (HR 7.42).
Conclusion
BCT of DCIS bears the risk of residual disease progressing into invasive local recurrence and distant metastasis. A re-excision or mastectomy is therefore desired in all patients with unclear margins. Mastectomy treatment is associated with optimal local control and might be considered for patients younger than 40 years who are at high risk of local recurrence.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>17987342</pmid><doi>10.1245/s10434-007-9659-2</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2008, Vol.15 (1), p.235-243 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adult Aged Aged, 80 and over Breast Neoplasms - radiotherapy Breast Neoplasms - surgery Breast Neoplasms - therapy Breast Oncology Carcinoma, Intraductal, Noninfiltrating - radiotherapy Carcinoma, Intraductal, Noninfiltrating - surgery Carcinoma, Intraductal, Noninfiltrating - therapy Clinical outcomes Combined Modality Therapy Female Humans Mastectomy, Segmental Medicine Medicine & Public Health Middle Aged Neoplasm Invasiveness Neoplasm Recurrence, Local - pathology Oncology Surgery Surgical Oncology Survival Rate Treatment Outcome |
| title | Clinical Outcome after Selective Treatment of Patients Diagnosed with Ductal Carcinoma In Situ of the Breast |
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