J Breast Cancer.  2017 Dec;20(4):327-332. 10.4048/jbc.2017.20.4.327.

Selective Radiation Therapy for Ductal Carcinoma In Situ Following Breast-Conserving Surgery According to Age and Margin Width: Korean Radiation Oncology Group 11-04 and 16-02 Studies

• Kim K
• Kim JH
• Kim YB
• Suh CO
• Shin KH
• Kim JH
• Kim TH
• Jung SY
• Choi DH
• Park W
• Ahn SD
• Kim SS
• Yea JW
• Kang MK
• Kim DW
• Kim YJ

• KMID: 2398201
• DOI: http://doi.org/10.4048/jbc.2017.20.4.327

Abstract

PURPOSE
The optimal indications for omitting adjuvant radiation therapy (RT) after breast-conserving surgery are still controversial in ductal carcinoma in situ (DCIS) of the breast. The purpose of this study was to validate the role of postoperative RT in DCIS patients aged ≤50 years and with tumor margin widths of <1 cm, both of which have been proven to be high-risk features for recurrence in cohorts not receiving RT.
METHODS
Using two multicenter retrospective studies on DCIS, a pooled analysis was performed among patients aged ≤50 years and with margin widths < 1 cm. All patients underwent breast-conserving surgery. Two hundred thirty-two patients received postoperative RT, while 54 did not. The median follow-up period was 77 months (range, 2-190 months) and 70 months (range, 5-166 months) in the patients who received RT and those who did not, respectively.
RESULTS
The patients who received RT had larger tumors (p < 0.001), higher nuclear grade (p < 0.001), closer margin width (p < 0.001), and negative estrogen receptor expression (p=0.010) compared with those who did not receive RT. During the follow-up period, there were 17 ipsilateral breast tumor recurrences (IBTRs) as follows: invasive carcinoma in 10 patients and DCIS in seven. In the univariate analysis, the treatment with RT and human epidermal growth factor receptor 2 (HER2) status were significant risk factors for IBTR. The 7-year IBTR rates with and without postoperative RT were 3.6% and 13.1%, respectively (p=0.008). HER2-positive tumors had a higher IBTR rate than the HER2-negative tumors (7-year rate, 13.6% vs. 3.9%; p=0.003).
CONCLUSION
Postoperative RT following breast-conserving surgery significantly reduced the 7-year IBTR rate in the DCIS patients aged ≤50 years and with margin widths < 1 cm. HER2 positivity was associated with increased IBTR in these patients.

Keyword

Age factors; Ductal carcinoma in situ; Margins of excision; Radiotherapy

MeSH Terms

Age Factors
Breast
Breast Neoplasms
Carcinoma, Ductal*
Carcinoma, Intraductal, Noninfiltrating*
Cohort Studies
Estrogens
Follow-Up Studies
Humans
Mastectomy, Segmental*
Radiation Oncology*
Radiotherapy
Receptor, Epidermal Growth Factor
Recurrence
Retrospective Studies
Risk Factors
Estrogens
Receptor, Epidermal Growth Factor

Figure

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  Figure 1 Ipsilateral breast tumor recurrence curves according to the receipt of postoperative radiation therapy (RT).

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