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DCIS Treated with Excision Alone Using the National Comprehensive Cancer Network (NCCN) Guidelines

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In 2008, the NCCN published guidelines allowing low-risk DCIS patients to be treated by excision alone. The goal of this study was to determine local and distant recurrence and breast-cancer specific survival in patients with DCIS that meet NCCN criteria and are treated with excision alone.

Methods

A prospective, single institution database was analyzed for patients with the following: pure ductal carcinoma in situ (no microinvasion), tumor extent 20 mm or less, age ≥50 years, margin width ≥2 mm, and nuclear grade 1 or 2 (non-high grade). Patients were treated with excision alone. Kaplan-Meier analysis was used to determine recurrence and survival rates.

Results

A total of 205 patients were treated with excision alone. The median age was 59 years. The median time of follow-up was 51 months. The median extent of disease was 8 mm. There were a total of nine local recurrences. The 6-year probability of local recurrence was 6.6  %. The 12-year probability of local recurrence was 7.8  %. The 12-year breast cancer-specific survival probability was 100  %.

Conclusions

The 12-year local recurrence rate for DCIS patients in NSABP Protocol B-17 treated with excision alone was 32 %, and for excision plus radiation therapy, it was 16 %. In this study, retrospectively applying the NCCN Guidelines to our patients, the 12-year local recurrence rate for excision alone was 7.8 %. Patients with a low risk of local recurrence, if treated by excision alone, can be safely selected using the NCCN Guidelines.

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References

  1. Lagios M, Page D, Silverstein M. Prospective study of wide excision alone for ductal carcinoma in situ of the breast [comment]. J Clin Oncol. 2006;24:3809-11.

    Article  PubMed  Google Scholar 

  2. Lagios MD. Duct carcinoma in situ: pathology and treatment. Surg Clin N Am. 1990;70:853-71.

    PubMed  CAS  Google Scholar 

  3. Schwartz G. The role of excision and surveillance alone in subclinical DCIS of the breast. Oncology. 1994;8(2):21-6.

    PubMed  CAS  Google Scholar 

  4. Schwartz G, Finkel G, Carcia J, Patchefsky A. Subclinical ductal carcinoma in situ of the breast: treatment by local excision and surveillance alone. Cancer. 1992;70:2468-74.

    Article  PubMed  CAS  Google Scholar 

  5. Silverstein MJ, Lagios M, Groshen S, et al. The influence of margin width on local control in patients with ductal carcinoma in situ (DCIS) of the breast. New Engl J Med. 1999;340:1455-61.

    Article  PubMed  CAS  Google Scholar 

  6. Silverstein MJ, Poller D, Craig P, et al. A prognostic index for ductal carcinoma in situ of the breast. Cancer. 1996;77:2267-74.

    Article  PubMed  CAS  Google Scholar 

  7. Fisher B, Costantino J, Redmond C, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med. 1993;328:1581-6.

    Article  PubMed  CAS  Google Scholar 

  8. Silverstein MJ. The University of Southern California / Van Nuys Prognostic Index for ductal carcinoma in situ of the breast. Am J Surg. 2003;186:337-43.

    Article  PubMed  Google Scholar 

  9. Silverstein MJ, Lagios M, Recht A, eds. Ductal carcinoma in situ of the breast, 2nd edn. Philadelphia: Lippincott Williams & Wilkins; 2002.

    Google Scholar 

  10. Carlson RW, Allred DC, Anderson BO, et al. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. 2008; www.nccn.org, 2008.

  11. Therialt RT, Carlson RW, Allred C, et al. NCCN Guidelines Breast Version 2.2013. Breast Cancer. 2013; www.NCCN.org.

  12. Lester SC, Bose S, Chen YY, et al. Protocol for the examination of specimens from patients with ductal carcinoma in situ of the breast. Arch Pathol Lab Med. 2009;133(1):15-25.

    PubMed  Google Scholar 

  13. Fisher B, Redmond C, ER F. Radiation therapy for in situ or localized breast cancer: the authors reply. N Engl J Med. 1993;329:1578.

    Google Scholar 

  14. Fisher E, Dignam J, Tan-Chie E, et al. Pathologic findings from the National Adjuvant Breast Project (NSABP) eight-year update of Protocol B-17: intraductal carcinoma. Cancer. 1999;86:429-38.

    Article  PubMed  CAS  Google Scholar 

  15. Wapnir I, Dignam J, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103(6):478-88.

    Article  PubMed  Google Scholar 

  16. Viani GA, Stefano EJ, Afonso SL, et al. Breast-conserving surgery with or without radiotherapy in women with ductal carcinoma in situ: a meta-analysis of randomized trials. Radiation Oncol. 2007;2:28-39.

    Article  Google Scholar 

  17. (EBCTCG) EBCTCG. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Monogr. 2010;41:162-77.

    Google Scholar 

  18. Lagios M, Margolin F, Westdahl P, Rose N. Mammographically detected duct carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer. 1989;63:619-24.

    Article  Google Scholar 

  19. Lagios M, Westdahl P, Margolin F, Rose M. Duct Carcinoma in situ: Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures. Cancer. 1982;50:1309-14.

    Article  PubMed  CAS  Google Scholar 

  20. Schwartz G, Patchefsky A, Finkelstein S, et al. Nonpalpable in situ ductal carcinoma of the breast. Arch Surg. 1989;124:29-32.

    Article  PubMed  CAS  Google Scholar 

  21. Silverstein MJ. An argument against routine use of radiotherapy for ductal carcinoma in situ. Oncology. 2003;17(11):1511-46.

    PubMed  Google Scholar 

  22. Lagios M. Controversies in diagnosis, biology, and treatment. Breast J. 1995;1:68-78.

    Article  Google Scholar 

  23. Lagios M. The Lagios experience. In: Silverstein MJ, Recht A, Lagios M, eds. Ductal carcinoma in situ of the breast, 2nd edn. Philadelphia: Lippincott Williams & Wilkins; 2002:303-7.

    Google Scholar 

  24. Silverstein MJ, Epstein M, Sposto R. Predicting local recurrence in patients with DCIS. In: Silverstein MJ, Recht A, Lagios M, eds. Ductal carcinoma in situ of the breast, 2nd edn. Philadelphia: Lippincott Williams & Wilkins; 2002.

    Google Scholar 

  25. Hughes L, Molin W, Page D, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009;27(32):5319-24.

    Article  PubMed  Google Scholar 

  26. Darby S, McGale P, Taylor C, Peto R. Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300,000 women un US SEER cancer registries. Lancet Oncol. 2005;6:557-65.

    Article  PubMed  Google Scholar 

  27. Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368:987-98.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Breast Surgery, Hoag Memorial Hospital Presbyterian, University of Southern California, Los Angeles, CA, USA

    Patricia Wehner MD & Melvin J. Silverstein MD, FACS

  2. The Breast Cancer Consultation Service location, Boston, MA, USA

    Michael D. Lagios MD

Authors
  1. Patricia Wehner MD
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  2. Michael D. Lagios MD
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  3. Melvin J. Silverstein MD, FACS
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Correspondence to Patricia Wehner MD.

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Wehner, P., Lagios, M.D. & Silverstein, M.J. DCIS Treated with Excision Alone Using the National Comprehensive Cancer Network (NCCN) Guidelines. Ann Surg Oncol 20, 3175–3179 (2013). https://doi.org/10.1245/s10434-013-3176-2

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  • DOI: https://doi.org/10.1245/s10434-013-3176-2

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