Abstract
Ductal carcinoma in situ of the breast is associated with low mortality rates, but local relapse is a matter of concern in this disease. Risk factors for local relapse include young age, close or positive margins, and tumor necrosis. Whole breast irradiation following breast-conserving surgery for ductal carcinoma in situ significantly reduces the risk of local relapse as compared to breast-conserving surgery alone. Studies point to similar outcomes between breast-conserving surgery plus radiotherapy and mastectomy, in the absence of extensive disease. A complementary boost to the surgical bed improves outcomes for patients with invasive breast cancer. However, the effect of this strategy has never been prospectively reported for ductal carcinoma in situ. Two randomized controlled trials assessing this issue are ongoing. This paper represents an update on available literature about radiotherapy for DCIS with a special focus on the role of a radiotherapy boost to the tumor bed.
Highlights
Ductal carcinoma in situ (DCIS) is a proliferation of malignant cells inside galactophoric ducts without basal membrane invasion
Mastectomy may be the preferred strategy in case of diffuse suspicious-appearing microcalcifications in the breast, inability to obtain margin control by lumpectomy and/or reexcision(s), medical contraindication to irradiation, and when an unfavorable tumor-to-breast size ratio does not permit margin-negative lumpectomy with cosmetically acceptable results [4]
International Journal of Surgical Oncology multicenter phase 3 studies assessing the role of surgical bed boost following whole breast irradiation (WBI)
Summary
Ductal carcinoma in situ (DCIS) is a proliferation of malignant cells inside galactophoric ducts without basal membrane invasion. Accounting for approximately 20 to 30% of the breast cancer cases [1], DCIS is heterogeneous in clinical presentation, varying from a palpable mass, mammographically detected tumor, or nipple discharge [2]. Multicentric, and extensive tumors are more likely to undergo mastectomy than breast-conserving surgery (BCS), because of a higher risk of recurrence [3]. A number of randomized controlled trials of adjuvant radiotherapy have demonstrated a reduced risk of both invasive and local recurrences, as well as a low risk of side effects [6, 7]. A radiation boost to the tumor bed has been shown to significantly improve local control in patients with invasive breast cancer [8, 9]. International Journal of Surgical Oncology multicenter phase 3 studies assessing the role of surgical bed boost following whole breast irradiation (WBI)
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