Francesca De Lorenzi1, Julien Di Bella2, Patrick Maisonneuve3, Nicole Rotmensz3, Giovanni Corso4, Roberto Orecchia5, Marco Colleoni6, Giovanni Mazzarol7, Mario Rietjens2, Pietro Loschi2, Stefano Marcelli8, Paolo Veronesi4, Viviana Galimberti4. 1. Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. Electronic address: francesca.delorenzi@ieo.it. 2. Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. 3. Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. 4. Department of Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. 5. Division of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. 6. Medical Senology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. 7. Division of Pathology and Laboratory Medicine, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. 8. Department of Plastic and Reconstructive Surgery, IRCCS Policlinico San Donato, piazza Edmondo Malan 1, San Donato Milanese, 20097, Milan, Italy.
Abstract
BACKGROUND: Few data exist in literature regarding oncoplastic surgery (ONC) and ductal carcinoma in situ (DCIS). The role of ONC in the treatment of DCIS has not been elucidated yet: no case-control study has yet been published on the issue and no long-term oncologic results are reported. METHODS: Using the European Institute of Oncology (IEO) institutional breast cancer data base we investigated the oncologic safety of ONC for DCIS comparing a consecutive series of 44 patients who have underwent ONC followed by external irradiation for DCIS (Group A-study group) with 375 patients who received conservation alone followed by external irradiation for DCIS (Group B control group) in the same period. We excluded patients presenting with secondary tumors or local relapses and those requiring re-excision or completion mastectomy for positive margins. Primary endpoints were disease-free survival (DFS) and ipsilateral breast tumor recurrence (IBTR) within the study group and comparison with the control group. RESULTS: Events rates and death rates were similar in the two groups. The average annual rate of invasive IBTR in group A and B was 1.6% and 1.0% respectively. No difference in the rate of lymphnode metastasis, distant metastasis, contralateral breast cancer, other primary cancer or death was observed across the two groups. CONCLUSIONS: Our findings suggest the safety of ONC and irradiation for the management of DCIS extending the indications for conservation in DCIS patients otherwise treated with mastectomy. It provides the best available evidence supporting ONC as a valid treatment option for the management of DCIS.
BACKGROUND: Few data exist in literature regarding oncoplastic surgery (ONC) and ductal carcinoma in situ (DCIS). The role of ONC in the treatment of DCIS has not been elucidated yet: no case-control study has yet been published on the issue and no long-term oncologic results are reported. METHODS: Using the European Institute of Oncology (IEO) institutional breast cancer data base we investigated the oncologic safety of ONC for DCIS comparing a consecutive series of 44 patients who have underwent ONC followed by external irradiation for DCIS (Group A-study group) with 375 patients who received conservation alone followed by external irradiation for DCIS (Group B control group) in the same period. We excluded patients presenting with secondary tumors or local relapses and those requiring re-excision or completion mastectomy for positive margins. Primary endpoints were disease-free survival (DFS) and ipsilateral breast tumor recurrence (IBTR) within the study group and comparison with the control group. RESULTS: Events rates and death rates were similar in the two groups. The average annual rate of invasive IBTR in group A and B was 1.6% and 1.0% respectively. No difference in the rate of lymphnode metastasis, distant metastasis, contralateral breast cancer, other primary cancer or death was observed across the two groups. CONCLUSIONS: Our findings suggest the safety of ONC and irradiation for the management of DCIS extending the indications for conservation in DCIS patients otherwise treated with mastectomy. It provides the best available evidence supporting ONC as a valid treatment option for the management of DCIS.
Authors: Francesca De Lorenzi; Francesco Borelli; Eleonora Pagan; Vincenzo Bagnardi; Nickolas Peradze; Barbara Alicia Jereczek-Fossa; Cristina Leonardi; Giovanni Mazzarol; Giorgio Favia; Giovanni Corso; Emilia Montagna; Mario Rietjens; Paolo Veronesi Journal: Ann Surg Oncol Date: 2021-10-06 Impact factor: 5.344