Vicini F A, Lacerna M D, Goldstein N S, Horwitz E M, Dmuchowski C F, White J R, Gustafson G S, Ingold J A, Martinez A A
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Int J Radiat Oncol Biol Phys. 1997 Oct 1;39(3):627-35. doi: 10.1016/s0360-3016(97)00314-3.
We reviewed our institution's experience treating predominantly mammographically detected ductal carcinoma in situ (DCIS) with breast-conserving therapy (BCT) to determine if any clinical, pathologic, or treatment-related factors affected outcome.
From January 2, 1980 to January 6, 1992, 107 breasts in 105 patients were treated with BCT at William Beaumont Hospital, Royal Oak, MI. All patients underwent at least an excisional biopsy and 70 patients (65%) were reexcised. All patients received whole-breast irradiation to a median dose of 50.4 Gy (range 43.1 to 56.0 Gy). Ninety-nine patients (93%) received a supplemental boost to the tumor bed for a median total dose of 60.4 Gy (range 59.1 to 71.8 Gy) using either photons (2 patients), electrons (69 patients), or an interstitial implant (28 patients).
With a median follow-up of 78 months, 10 patients have failed in the treated breast for a 5- and 10-year actuarial local control rate of 91.2 and 89.8%, respectively. Thirteen percent of the population have been followed for 10 years or more. Three recurrences were pure DCIS, and seven were invasive. All patients were salvaged with mastectomy. Nine patients remain without evidence of disease a median of 30.6 months after surgery. One patient failed distantly 36 months after local recurrence for an ultimate cause specific survival of 99%. Potential clinical (age, mammographic findings, method of detection, etc.), pathologic (nuclear grade, margins, etc.), and treatment-related factors (dose, boost technique, reexcision status, etc.) affecting outcome were analyzed. No variable was found to be associated with an ipsilateral breast tumor recurrence. However, when only recurrences that occurred within or immediately adjacent to the lumpectomy cavity were analyzed, both margin status and the extent of cancerization of lobules (COL) near the surgical margin were associated with the development of a local recurrence.
Patients treated with BCT for predominantly mammographically detected DCIS achieve excellent rates of local control and overall survival. Both margin status and the extent of COL near the surgical margin appear to be associated with recurrences within or immediately adjacent to the lumpectomy cavity. These data suggest that careful attention to the completeness of surgical resection of DCIS is an important determinant of outcome.
我们回顾了本机构以保乳治疗（BCT）为主治疗主要通过乳腺钼靶检查发现的导管原位癌（DCIS）的经验，以确定是否有任何临床、病理或治疗相关因素会影响治疗结果。
1980年1月2日至1992年1月6日，密歇根州皇家橡树市威廉·博蒙特医院对105例患者的107个乳房进行了保乳治疗。所有患者均至少接受了切除活检，70例患者（65%）进行了再次切除。所有患者均接受全乳照射，中位剂量为50.4 Gy（范围43.1至56.0 Gy）。99例患者（93%）接受了对瘤床的补充加量照射，使用光子（2例患者）、电子（69例患者）或组织间插植（28例患者），中位总剂量为60.4 Gy（范围59.1至71.8 Gy）。
中位随访78个月，10例患者在接受治疗的乳房出现复发，5年和10年的精算局部控制率分别为91.2%和89.8%。13%的患者随访时间达10年或更长。3例复发为单纯DCIS，7例为浸润性癌。所有患者均通过乳房切除术挽救治疗。9例患者术后中位30.6个月仍无疾病证据。1例患者在局部复发36个月后出现远处转移，最终特定病因生存率为99%。分析了可能影响治疗结果的临床因素（年龄、乳腺钼靶检查结果、检测方法等）、病理因素（核分级、切缘等）和治疗相关因素（剂量、加量技术、再次切除情况等）。未发现任何变量与同侧乳腺肿瘤复发相关。然而，当仅分析在肿块切除腔内或紧邻肿块切除腔发生的复发时，切缘状态和手术切缘附近小叶癌变范围（COL）均与局部复发的发生相关。
以保乳治疗为主治疗主要通过乳腺钼靶检查发现的DCIS的患者，局部控制率和总生存率均极佳。切缘状态和手术切缘附近的COL范围似乎均与肿块切除腔内或紧邻肿块切除腔的复发相关。这些数据表明，仔细关注DCIS手术切除的完整性是治疗结果的重要决定因素。
