K Clements1, D Dodwell2, G Lawrence1, G Ball3, A Francis4, S Pinder5, E Sawyer5, M Wallis6, A M Thompson7. 1. West Midlands Cancer Screening QA Reference Centre, Public Health England, 1st Floor, 5 St Philip's Place, Birmingham B3 2PW, UK. 2. Institute of Oncology, Level 4 - Bexley Wing, St James Hospital, Leeds LS9 7TF, UK. Electronic address: david.dodwell@nhs.net. 3. Van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham NG11 8NS, UK. 4. Ward West 2, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK. 5. Research Oncology, Division of Cancer Studies, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. 6. Cambridge Breast Unit, Box 97 - NIHR Cambridge Biomedical Research Centre Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK. 7. Department of Breast Surgical Oncology, MD Anderson Cancer Center, 1400 Pressler Street, Houston 77030, USA.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Recurrence following mastectomy for DCIS is rare. A close (<1 mm) margin, large tumour size and microinvasion, may merit radiotherapy to reduce ipsilateral recurrence.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Recurrence following mastectomy for DCIS is rare. A close (<1 mm) margin, large tumour size and microinvasion, may merit radiotherapy to reduce ipsilateral recurrence.
Authors: Megan E Tesch; Shoshana M Rosenberg; Laura C Collins; Julia S Wong; Laura Dominici; Kathryn J Ruddy; Rulla Tamimi; Lidia Schapira; Virginia F Borges; Ellen Warner; Steven E Come; Ann H Partridge Journal: Ann Surg Oncol Date: 2022-08-12 Impact factor: 4.339