title: Salvage treatment for local recurrence following breast-conserving surgery and definitive irradiation for ductal carcinoma in situ (intraductal carcinoma) of the breast.
abstract: OBJECTIVE
  The purpose of the present study is to evaluate the outcome of salvage treatment for local recurrence in the breast following the initial treatment of ductal carcinoma in situ (intraductal carcinoma) with breast-conserving surgery and definitive breast irradiation.
  
  
  METHODS
  An analysis was performed of 42 local failures in the breast that occurred following the initial treatment of ductal carcinoma in situ (intraductal carcinoma) with breast-conserving surgery and definitive breast irradiation. At the time of the local recurrence, 23 cases (55%) showed invasive ductal carcinoma, and 19 cases (45%) showed intraductal carcinoma, one with associated Paget's disease. The surgical treatment at the time of local recurrence included mastectomy (n = 39), excision (n = 2), or other (n = 1). Adjuvant systemic therapy at the time of local recurrence included chemotherapy (n = 2), hormonal treatment (n = 7), both (n = 1), or none (n = 32). The median follow-up after salvage treatment was 3.7 years (mean = 4.0 years; range = 0.1-9.5 years).
  
  
  RESULTS
  The 5-year actuarial outcome following salvage treatment for the 42 local recurrences showed an overall survival rate of 78% and a cause-specific survival rate of 84%. The 5-year actuarial rate of freedom from distant metastases was 86%. None of the patients with histology of the local recurrence of intraductal carcinoma or with detection of the local recurrence with mammographic findings only developed distant metastatic disease after salvage treatment. The 5-year actuarial rate of freedom from chest wall recurrence following salvage mastectomy was 92%. All three of the patients who developed chest wall recurrence following salvage mastectomy also developed distant metastatic disease.
  
  
  CONCLUSIONS
  These results demonstrate that local recurrences following the initial treatment of ductal carcinoma in situ with breast-conserving surgery and definitive breast irradiation can be salvaged with high rates of survival, freedom from distant metastases, and freedom from chest wall recurrence. The results of salvage treatment support the use of breast-conserving surgery and definitive breast irradiation for the initial management of ductal carcinoma in situ of the breast.
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia.
authors.forename: L J
authors.initials: LJ
authors.lastname: Solin
authors.forename: A
authors.initials: A
authors.lastname: Fourquet
authors.forename: B
authors.initials: B
authors.lastname: McCormick
authors.forename: B
authors.initials: B
authors.lastname: Haffty
authors.forename: A
authors.initials: A
authors.lastname: Recht
authors.forename: D J
authors.initials: DJ
authors.lastname: Schultz
authors.forename: W
authors.initials: W
authors.lastname: Barrett
authors.forename: B L
authors.initials: BL
authors.lastname: Fowble
authors.forename: R
authors.initials: R
authors.lastname: Kuske
authors.forename: M
authors.initials: M
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000601:surgery*; D010052:Ovariectomy; D011379:Prognosis; D016879:Salvage Therapy; D013629:Tamoxifen / Q000627:therapeutic use
chemical_list: D013629:Tamoxifen