Solin L J, Fourquet A, Vicini F A, Haffty B, Taylor M, McCormick B, McNeese M, Pierce L J, Landmann C, Olivotto I A, Borger J, de La Rochefordiere A, Schultz D J
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Cancer. 2001 Mar 15;91(6):1090-7.
The purpose of the current study is to evaluate the outcome of salvage treatment for local recurrence after breast-conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ (DCIS; intraductal carcinoma) of the breast.
An analysis was performed of 42 patients with local only first failure (n = 41) or local-regional only first failure (n = 1) after breast-conserving surgery and radiation treatment had been given for DCIS of the breast. Surgical treatment at the time of local recurrence included mastectomy (n = 37; 88%) or excision (n = 5; 12%). Adjuvant systemic therapy at the time of local recurrence was chemotherapy (n = 3; 7%), tamoxifen (n = 8; 19%), both (n = 1; 2%), none (n = 29; 69%), or unknown (n = 1; 2%). The median interval from the time of initial treatment to local recurrence was 4.8 years (range = 1.0-15.2 yrs). The median follow-up after salvage treatment was 4.5 years (range = 0.2-12.8 yrs).
At the time of the local recurrence, 22 patients (52%) had invasive ductal carcinoma, 18 patients (43%) had DCIS, 1 patient (2%) had invasive lobular carcinoma, and 1 patient (2%) had angiosarcoma. After salvage treatment, the rate of overall survival and the rate of cause specific survival for all 42 patients were 92% at both 5- and 8-years after treatment. The rate of freedom from distant metastases was 89% at 5 and 8 years. Favorable prognostic factors after salvage treatment were DCIS as the histology of the local recurrence and mammography only as the method of detection of the local recurrence.
The results of salvage treatment in the current study demonstrated that local recurrences were salvaged with high rates of survival and freedom from distant metastases. These results support the use of breast-conserving surgery and radiation for initial management of DCIS of the breast.
本研究旨在评估保乳手术联合放疗作为乳腺钼靶检测到的导管原位癌（DCIS；导管内癌）初始治疗后局部复发的挽救性治疗结果。
对42例仅出现局部首次复发（n = 41）或仅出现局部区域首次复发（n = 1）的患者进行分析，这些患者曾接受过乳腺DCIS的保乳手术和放射治疗。局部复发时的手术治疗包括乳房切除术（n = 37；88%）或切除术（n = 5；12%）。局部复发时的辅助全身治疗为化疗（n = 3；7%）、他莫昔芬（n = 8；19%）、两者皆用（n = 1；2%）、未用（n = 29；69%）或情况不明（n = 1；2%）。从初始治疗到局部复发的中位间隔时间为4.8年（范围 = 1.0 - 15.2年）。挽救性治疗后的中位随访时间为4.5年（范围 = 0.2 - 12.8年）。
局部复发时，22例患者（52%）患有浸润性导管癌，18例患者（43%）患有DCIS，1例患者（2%）患有浸润性小叶癌，1例患者（2%）患有血管肉瘤。挽救性治疗后，所有42例患者在治疗后5年和8年的总生存率及病因特异性生存率均为92%。5年和8年时无远处转移生存率为89%。挽救性治疗后的有利预后因素为局部复发组织学类型为DCIS以及仅通过乳腺钼靶检查发现局部复发。
本研究中挽救性治疗的结果表明，局部复发通过高生存率和无远处转移得以挽救。这些结果支持将保乳手术和放疗用于乳腺DCIS的初始治疗。
