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Relationship between excision volume, margin status, and tumor size with the development of local recurrence in patients with ductal carcinoma‐in‐situ treated with breast‐conserving therapy
Author(s) -
Vicini Frank A.,
Kestin Larry L.,
Goldstein Neal S.,
Baglan Kathy L.,
Pettinga Jane E.,
Martinez Alvaro A.
Publication year - 2001
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.1041
Subject(s) - medicine , ductal carcinoma , breast conserving surgery , radiation therapy , biopsy , margin (machine learning) , multivariate analysis , surgical margin , breast cancer , statistical significance , radiology , wide local excision , surgery , mammary gland , mastectomy , cancer , resection , machine learning , computer science
Background and Objectives We reviewed our institution's experience treating patients with ductal carcinoma‐in‐situ (DCIS) with breast‐conserving therapy (BCT) to help define the interrelationship between excision volume, margin status, and tumor size with local recurrence. Methods From January 1980 to December 1993, 146 patients received BCT for DCIS. All patients underwent excisional biopsy and 95 cases (64%) underwent re‐excision. Each patient received whole breast radiation to a median dose of 45 Gy. An additional 139 cases (94%) received a supplemental boost to the tumor bed (median total dose 60.4 Gy). The median follow‐up is 7.2 years. Results Seventeen patients developed an ipsilateral breast failure for a 5‐ and 10‐year actuarial rate of 10.2 and 12.4%, respectively. On multivariate analysis, patient age, margin status, the number of slides containing DCIS, the number of DCIS/cancerization of lobules (COL) foci near (< 5 mm) the margin, and a smaller volume of excision (< 60 cm 3 ) were all independently associated with outcome. Although the local recurrence rate generally decreased as margin distance increased, these differences did not achieve statistical significance unless the volume of excision was taken into consideration. Conclusions These findings suggest that the success of BCT is directly related to the degree of surgical removal of DCIS and that margin status alone may be suboptimal in defining excision adequacy. J. Surg. Oncol. 2001;76:245–254. © 2001 Wiley‐Liss, Inc.