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Long-term outcomes of breast-conserving therapy for women with ductal carcinoma in situ

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Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusions

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.

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Funding

There was no specific funding supporting this research.

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Authors and Affiliations

  1. Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Laura E. G. Warren, Alexander Capuco, Rinaa S. Punglia, Julia S. Wong & Jennifer R. Bellon

  2. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    Yu-Hui Chen

  3. Department of Radiation Oncology, University of Washington, Seattle, WA, USA

    Lia M. Halasz

  4. Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA

    Jane E. Brock

  5. Department of Surgery, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA, USA

    Mehra Golshan

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  1. Laura E. G. Warren
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Correspondence to Laura E. G. Warren.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The DF/HCC institutional review board approved this study and waived the requirement for informed consent.

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Warren, L.E.G., Chen, YH., Halasz, L.M. et al. Long-term outcomes of breast-conserving therapy for women with ductal carcinoma in situ. Breast Cancer Res Treat 178, 607–615 (2019). https://doi.org/10.1007/s10549-019-05428-0

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  • DOI: https://doi.org/10.1007/s10549-019-05428-0

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