Cutuli B, Lemanski C, Le Blanc-Onfroy M, de Lafontan B, Cohen-Solal-Le-Nir C, Fondrinier E, Mignotte H, Giard S, Charra-Brunaud C, Auvray H, Gonzague-Casabianca L, Quétin P, Fay R
Radiation Oncology Department, Institut du Cancer Courlancy, 38, rue de Courlancy, 51100 Reims, France.
Cancer Radiother. 2013 Jun;17(3):196-201. doi: 10.1016/j.canrad.2013.01.011. Epub 2013 Mar 26.
Ductal carcinoma in situ overall prognosis is excellent, but after breast conserving surgery, with or without radiotherapy, local recurrences can lead to locoregional or distant evolution and death. However, there are few data on optimal local recurrences treatment and long-term impact on survival.
This study included 195 women treated from 1985 to 1996 by conservative surgery (CS) or conservative surgery followed by radiotherapy (CS+RT), presenting local recurrences, with a 156-month median follow-up.
Eighty-two out of 195 (42%) local recurrences were non-invasive (in situ) and 113 (58%) invasive. In situ local recurrence was discovered by mammography in 80.5% of the cases versus 47.5% for invasive local recurrence (P=0.0001). Salvage mastectomy was used in 53% of the cases after conservative surgery and 75% after conservative surgery followed by radiotherapy. The axillary nodal involvement rates were 11.8% and 25.8% among 17 and 62 patients with in situ and invasive local recurrences. Among 113 patients with invasive local recurrences and 82 with in situ local recurrences, 19 (16.8%) and three (3.6%) developed metastases, respectively. Among invasive local recurrences, comedocarcinoma subtype was highly predictive of subsequent metastases (32% versus 4.4%, P<0.0007).
Invasive local recurrence after ductal carcinoma in situ treatment could be a dramatic event, fully changing long-term prognosis. Early mammographic local recurrence diagnosis (if possible still at non-invasive stage) seems essential to avoid or minimize metastatic risk. Mastectomy remains the safest option but, in some cases, a new conservative approach could be discussed.
导管原位癌总体预后良好，但在保乳手术后，无论是否接受放疗，局部复发都可能导致局部区域进展或远处转移，甚至死亡。然而，关于局部复发的最佳治疗方法及其对生存的长期影响的数据却很少。
本研究纳入了1985年至1996年间接受保乳手术（CS）或保乳手术加放疗（CS+RT）治疗后出现局部复发的195名女性，中位随访时间为156个月。
195例局部复发中，82例（42%）为非浸润性（原位），113例（58%）为浸润性。原位局部复发经乳腺钼靶检查发现的比例为80.5%，而浸润性局部复发经乳腺钼靶检查发现的比例为47.5%（P=0.0001）。保乳手术后53%的病例采用了挽救性乳房切除术，保乳手术加放疗后这一比例为75%。17例原位局部复发患者和62例浸润性局部复发患者的腋窝淋巴结受累率分别为11.8%和25.8%。113例浸润性局部复发患者和82例原位局部复发患者中，分别有19例（16.8%）和3例（3.6%）发生转移。在浸润性局部复发中，粉刺癌亚型对后续转移具有高度预测性（32%对4.4%，P<0.0007）。
导管原位癌治疗后的浸润性局部复发可能是一个严重事件，会彻底改变长期预后。早期通过乳腺钼靶检查诊断局部复发（如果可能，仍处于非浸润阶段）似乎对于避免或最小化转移风险至关重要。乳房切除术仍然是最安全的选择，但在某些情况下，可以讨论新的保乳方法。
