Clinical Outcomes of Ductal Carcinoma In Situ of the Breast Treated with Partial Mastectomy without Adjuvant Radiotherapy

PURPOSE: Some recent trials suggest that postoperative adjuvant radiotherapy (RT) may be safely omitted after breast-conserving surgery (BCS) for some patients with ductal carcinoma in situ (DCIS). In this study, we reviewed clinical outcomes of patients with DCIS treated with partial mastectomy (PM) without adjuvant RT. MATERIALS AND METHODS: Medical records of 28 patients (29 breasts) with DCIS who were treated with PM, but without RT, between April 1991 and December 2010 were retrospectively analyzed. Based on established criteria (2.0 cm or less in size and no comedonecrosis), 18 patients were treated without RT after PM. Seven patients (8 breasts) who did not receive RT due to refusal were also included in this study. Three other patients were excluded because data concerning comedonecrosis were not available. RESULTS: For the 25 patients included in this study, the mean age of the 18 patients who met the criteria was 47.9+/-6.2 years, and 47.6+/-12.7 years for the 7 patients who did not. The mean sizes of the primary tumors were 0.6+/-0.4 cm and 0.9+/-0.3 cm, respectively, in these two groups. Among these 25 patients (26 breasts) treated without RT, we observed no ipsilateral breast tumor recurrence or mortality within a mean follow-up of 84 months. CONCLUSION: Based on this small number of cases, patients with DCIS, who were selected for tumor size less than 2 cm and absence of comedonecrosis, may be treated successfully with BCS; adjuvant RT may be omitted.

Radioterapia adjuvante no câncer de mama operável / Adjuvant radiotherapy in operable breast cancer

O tratamento do câncer de mama inicial começa com a obtenção do controle locorregional. A radioterapia adjuvante é uma modalidade de tratamento local utilizada no câncer de mama para reduzir a recidiva local após o tratamento cirúrgico. A associação entre um adequado controle local e o aumento de sobrevida tem sido frequentemente observada. Os mecanismos, entretanto, através dos quais a aplicação da radiação ionizante no sítio tumoral primário pode resultar em efeitos sistêmicos, são um grande motivo de debates. Este artigo revisa dados sobre o papel da radioterapia adjuvante no câncer de mama operável, tanto pós-cirurgia conservadora quanto pós- mastectomia, assim como seus resultados locais e sistêmicos

The treatment of early breast cancer begins with the locorregional control. Adjuvant radiotherapy is a local treatment modality employed in breast cancer to reduce the local recurrence following surgery. The association between optimal local control and improved survival has been commonly observed. The mechanisms however whereby the application of ionizing radiation to the primary tumor site can result in systemic effects is subject of much debate. This article reviews data about the role of adjuvant radiotherapy in operable breast cancer post-conservative surgery and post-mastectomy as well as its local and systemic results

Abordagem atual do carcinoma ductal in situ da mama / Current approach of ductal carcinoma in situ of the breast

Carcinoma ductal in situ (CDIS) é uma proliferação de células epiteliais malignas confinadas dentro da membrana basal dos ductos mamários. Houve um aumento expressivo do diagnóstico do CDIS nas duas últimas décadas devido aos programas de rastreamento de câncer de mama. Conseqüentemente, a abordagem de pacientes com estas lesões assume grande importância na prática clínica diária. A apresentação mais comum do CDIS na mamografia são as microcalcificações. Apesar dos avanços tecnológicos o agulhamento mamário guiado por mamografia continua sendo o método padrão para obtenção de material para o estudo histopatológico das alterações mamográficas suspeitas. As opções terapêuticas para o CDIS incluem mastectomia, excisão local combinada ou não com radioterapia. Abordagem axilar não é necessária no tratamento do CDIS puro sendo indicado em casos selecionados como no caso de micro-invasão ou em lesões extensas quando há indicação de mastectomia. Nestes casos a pesquisa do linfonodo sentinela pode ser uma excelente alternativa. Nos casos de cirurgia conservadora deve-se ter sempre a preocupação de obter margens cirúrgicas livres, sendo este o fator mais importante no controle local da doença. Apesar dos estudos mostrarem que o tamoxifeno reduz eventos invasivos e não invasivos, bilateralmente existem alguns efeitos adversos que devem ser discutidos com o paciente. Tendo em vista que o CDIS constitui um grupo heterogêneo de lesões e não uma única entidade e que as pacientes têm diferentes necessidades, utilizar um único enfoque para todos os CDIS e para todas as pacientes não é adequado. Por isto a seleção do tratamento para as pacientes com CDIS deve ser individualizada. A tomada de decisões terapêuticas deve ser compartilhada entre todos os médicos especialistas envolvidos, levando-se em conta as particularidades de cada paciente e sua doença

Tratamiento del carcicoma ductal in situ / Treatment of ductal carcinoma in situ

El Carcicoma Ductal In Situ (CDIS) se diagnostica preferentemente por el hallazgo de microcalcificaciones en la mamografía. El tratamiento consiste en cirugía conservadora asociada a radioterapia post operatoria en caso de que la relación del tamaño de la lesión y el tamaño de la mama lo permita, o mastectomía total seguida o no de reconstrucción inmediata, en caso de lesiones extensas o multicéntricas. Aún no se logra identificar con precisión un subgrupo de pacientes que tratadas con cirugía conservadora, no requiera radioterapia. La disección axilar no está indicada en casos de CDIS puros. La biopsia del ganglio centinela se recomienda en situaciones especiales, las cuales se enumeran. El tratamiento adyuvante con tamoxifeno está indicado en las pacientes con receptores de estrógenos positivos. En este subgrupo de pacientes, la indicación de tamoxifeno debe ser discutida con cada paciente, dados los efectos secundarios de este medicamento. La elección del mejor tratamiento para una paciente en particular, debe considerar la extensión de la enfermedad y tiene que compatibilizar la obtención de márgenes sanos con un buen resultado cosmético, además de tomar en cuenta la preferencia de la paciente.

Radioterapia en el manejo del cáncer intraductal de mama / Radiotherapy in the management of ductal carcinoma in situ of the breast

La radioterapia postoperatoria constituye un integrante esencial del manejo conservador del cáncer de mama in situ. Diversos estudios prospectivos y retrospectivos demuestran una reducción del riesgo de recurrencia invasora y no invasora de aproximadamente un 50 por ciento o más de los casos, sin afectar significativamente las tasas de sobrevida. Existen algunos ensayos retrospectivos sesgados que sugieren que en pacientes seleccionados, con lesiones de bajo grado y bordes quirúrgicos amplios, la radioterapia podría obviarse. Sin embargo, hasta ahora no se ha logrado definir un grupo de riesgo en el que no exista beneficio de la radioterapia luego del manejo conservador.

Tratamiento conservador del carcinoma ductal in situ de la mama / Conservative management of in situ ductal carcinoma of the breast

Background: since the widespread use of mammography, the incidence of ductal carcinoma in situ of the breast has increased. Until few years ago the standard treatment was mastectomy, however from the analysis of conservative treatment trials for invasive carcinoma, it was evident that ductal carcinoma in situ could also be treated conservatively. This was confirmed later by randomized trials. Aim: to analyze the experience of our Institution with conservative treatment of ductal carcinoma in situ of the breast. Patients and methods: a search through the data base of our Institution found 69 patients treated with lumpectomy and radiotherapy between the years 1976 and 1997. Results: twenty three of 69 patients (33 percent) were diagnosed because of a palpable mass. Eleven of twelve were diagnosed prior to 1990 and 12 of 57 after 1990. With a median follow-up of 48 months local control and overall survival is 97 percent. None of the patients underwent mastectomy. Conclusions: conservative treatment of ductal carcinoma in situ of the breast is a reasonable alternative, mainly if we realize that with increasing frequency-the diagnosis is made through mammography and with non-palpable lesions. The results reported in this study are similar to those reported by other centers

Cytogenetic Studies of Peripheral Leukocytes following Surgery and Radiotherapy in Patients with Breast Carcinoma

Chromosome analysis were carried out on peripheral blood leukocytes of breast cancer patient during the irradiation therapy after unilateral simple mastectomy. The observations were made at intervals varying from one to 5 weeks during the therapy and one month after the completion of tile treatment. During the first and second weeks of treatment normal metaphase was noted and during the 4th and 5th weeks, there were no mitotic figures from the cell population. The chromosomal aberrations found after 3 weeks of treatment were, 11% of simple chromatid breaks, 7% of chromatid interchanges (translocations) and 8% of fragments. One month after the completion of the course of treatment showed a return of mitosis and that total chromatid breaks had decreased to 5%. Radiation effects on cell division and chromosome aberration are discussed.