Chadha Manjeet, Portenoy Jason, Boolbol Susan K, Gillego Alyssa, Harrison Louis B
Department of Radiation Oncology, Beth Israel Medical Center, 10 Union Square East, New York, NY 10003, USA.
Int J Surg Oncol. 2012;2012:423520. doi: 10.1155/2012/423520. Epub 2012 Jun 13.
Background. DCIS treated by mastectomy ensures high local control rates. There is limited data on risk for relapse and lack of clear indication for adjuvant radiation therapy (RT). We report a retrospective review on a population of DCIS patients treated with mastectomy. The objective was to identify the overall incidence of relapse, risk factors for local recurrence, and accordingly for whom adjuvant postmastectomy RT may be considered. Methods. This is an IRB-approved retrospective study on a prospective breast cancer database. From 1997 to 2007, we identified 969 patients with diagnoses of DCIS, among them 211 breasts in 207 patients were treated with mastectomy and comprise the study group. Results. With a median followup of 55 months (4.6 years) the 10-year relapse-free survival is 97%. Two of 211 breasts (0.9%) treated with mastectomy developed a local-regional recurrence. Both the relapses were among patients defined as having <1 mm final mastectomy margin. Conclusions. The rare local relapse after mastectomy limits our ability to reliably identify risk factors for relapse. The consideration for postmastectomy RT should be based on an individualized risk evaluating surgical technique used, presence of BRCA mutation, grade and extent of tumor, and proximity of lesion to the margin of resection.
背景。采用乳房切除术治疗导管原位癌（DCIS）可确保较高的局部控制率。关于复发风险的数据有限，且辅助性放疗（RT）缺乏明确指征。我们报告了一项对接受乳房切除术的DCIS患者群体的回顾性研究。目的是确定复发的总体发生率、局部复发的危险因素，并据此确定哪些患者可考虑接受乳房切除术后辅助放疗。方法。这是一项经机构审查委员会（IRB）批准的、基于前瞻性乳腺癌数据库的回顾性研究。1997年至2007年期间，我们确定了969例诊断为DCIS的患者，其中207例患者的211个乳房接受了乳房切除术，构成研究组。结果。中位随访55个月（4.6年），10年无复发生存率为97%。接受乳房切除术的211个乳房中有2个（0.9%）发生了局部区域复发。这两例复发均发生在最终乳房切除切缘<1毫米的患者中。结论。乳房切除术后罕见的局部复发限制了我们可靠识别复发危险因素的能力。乳房切除术后放疗的考虑应基于个体化风险评估，评估内容包括所采用的手术技术、BRCA突变的存在情况、肿瘤的分级和范围以及病变与切除边缘的接近程度。
