Clements K, Dodwell D, Lawrence G, Ball G, Francis A, Pinder S, Sawyer E, Wallis M, Thompson A M
West Midlands Cancer Screening QA Reference Centre, Public Health England, 1st Floor, 5 St Philip's Place, Birmingham B3 2PW, UK.
Institute of Oncology, Level 4 - Bexley Wing, St James Hospital, Leeds LS9 7TF, UK.
Eur J Surg Oncol. 2015 Oct;41(10):1406-10. doi: 10.1016/j.ejso.2015.07.021. Epub 2015 Aug 18.
A role for radiotherapy after mastectomy for ductal carcinoma in situ (DCIS) is unclear. Using a prospective audit of DCIS detected through the NHS Breast Screening Programme we sought to determine a rationale for the use of post mastectomy radiotherapy for DCIS.
Over a nine year period, from 9972 patients with screen-detected DCIS and complete surgical, pathology, radiotherapy and follow up data, 2944 women underwent mastectomy for DCIS of whom 33 (1.1%) received radiotherapy.
Use of post mastectomy radiotherapy was significantly associated with a close (<1 mm) pathology margin (χ(2)(1) 95.81; p < 0.00001), DCIS size (χ(2) (3) 16.96; p < 0.001) and the presence of microinvasion (χ(2)(1) 3.92; p < 0.05). At a median follow up 61 months, no woman who received radiotherapy had an ipsilateral further event, and only 1/33 women (3.0%) had a contralateral event. Of the women known not to have had radiotherapy post mastectomy, 45/2894 (1.6%) had an ipsilateral further event and 83 (2.9%) had a contralateral event.
Recurrence following mastectomy for DCIS is rare. A close (<1 mm) margin, large tumour size and microinvasion, may merit radiotherapy to reduce ipsilateral recurrence.
乳房切除术后放疗在导管原位癌（DCIS）治疗中的作用尚不清楚。我们通过对英国国家医疗服务体系（NHS）乳腺筛查计划中检测出的DCIS进行前瞻性审计，试图确定乳房切除术后放疗用于DCIS的依据。
在九年时间里，从9972例经筛查发现DCIS且有完整手术、病理、放疗及随访数据的患者中，2944例女性因DCIS接受了乳房切除术，其中33例（1.1%）接受了放疗。
乳房切除术后放疗的使用与病理切缘接近（<1mm）（χ²(1) 95.81；p < 0.00001）、DCIS大小（χ²(3) 16.96；p < 0.001）以及微浸润的存在（χ²(1) 3.92；p < 0.05）显著相关。中位随访61个月时，接受放疗的女性无一例发生同侧进一步事件，仅1/33例女性（3.0%）发生对侧事件。在已知乳房切除术后未接受放疗的女性中，45/2894例（1.6%）发生同侧进一步事件，83例（2.9%）发生对侧事件。
DCIS乳房切除术后复发罕见。切缘接近（<1mm）、肿瘤体积大及存在微浸润可能值得放疗以降低同侧复发率。
