Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
Breast Cancer Res Treat. 2019 Dec;178(3):607-615. doi: 10.1007/s10549-019-05428-0. Epub 2019 Sep 6.
Improved imaging, surgical techniques, and pathologic evaluation likely have decreased local recurrence rates for patients with ductal carcinoma in situ (DCIS). We present long-term outcomes of a large single-institution series after breast-conserving surgery (BCS) and adjuvant radiation therapy (RT).
We retrospectively reviewed the records of 245 women treated for DCIS with BCS and RT between 2001 and 2007. Competing risk analysis was used to calculate local recurrence (LR) as a first event with the development of a second non-breast malignancy, contralateral breast cancer, and death as competing first events.
At a median follow-up of 10.6 years, 4 patients had a LR (2 DCIS, 2 invasive) as a first event with a cumulative LR incidence of 0.0% and 1.5% at 5 and 10 years, respectively. Most patients had > 2 mm margins (90%), specimen radiographs (93%), and received a tumor bed boost (99%). The majority (60%) of patients with hormone receptor-positive disease received adjuvant endocrine therapy. Ten-year cumulative incidence of contralateral breast cancer (CBC) was 7.9%, second non-breast malignancy was 4.5%, and death unrelated to breast cancer was 3.5%. Family history, age at diagnosis, and receipt of endocrine therapy were not significantly associated with the development of CBC (all P > 0.05).
With mature follow-up, our rates of local recurrence following breast-conserving therapy for DCIS remain very low (1.5% at 10 years). The incidence of CBC was higher than the LR incidence. Predisposing factors for the development of CBC are worthy of investigation.
改良的成像、手术技术和病理评估可能降低了导管原位癌（DCIS）患者的局部复发率。我们展示了在接受保乳手术（BCS）和辅助放疗（RT）后，单一机构大型系列的长期结果。
我们回顾性地审查了 2001 年至 2007 年间接受 BCS 和 RT 治疗的 245 例 DCIS 患者的记录。竞争风险分析用于计算局部复发（LR）作为第一个事件，第二个非乳腺癌、对侧乳腺癌和死亡为竞争第一事件。
在中位数为 10.6 年的随访中，4 例患者（2 例 DCIS，2 例浸润性）作为第一个事件发生 LR，累积 LR 发生率分别为 0.0%和 1.5%，在 5 年和 10 年时。大多数患者的切缘>2mm（90%）、标本射线照相（93%）和接受肿瘤床加量照射（99%）。大多数激素受体阳性疾病患者（60%）接受了辅助内分泌治疗。10 年时对侧乳腺癌（CBC）的累积发生率为 7.9%，第二非乳腺癌为 4.5%，与乳腺癌无关的死亡为 3.5%。家族史、诊断时年龄和内分泌治疗的接受情况与 CBC 的发展无显著相关性（均 P>0.05）。
在成熟的随访中，我们对 DCIS 进行保乳治疗后的局部复发率仍然非常低（10 年时为 1.5%）。CBC 的发生率高于 LR 发生率。CBC 发展的易患因素值得研究。
