title: Ductal carcinoma in situ of the breast: results of treatment by conservative surgery and definitive irradiation.
abstract: OBJECTIVE
  To determine local control, survivorship, and cosmesis in women with ductal carcinoma in situ treated by conservative surgery and radiation therapy.
  
  
  METHODS
  We retrospectively analyzed the results of treatment in 56 women with in situ carcinoma of the breast, treated between 1976 and 1990 by conservative surgery and irradiation. Two women had bilateral tumors, for a total of 58 breasts at risk. All patients underwent gross excision of the tumor followed by radiation to the entire breast and a sequential boost to the tumor bed. Eight of the 21 evaluable tumors (38%) had inadequate pathologic margins at the time of excision. Routine re-excision was not performed. The median dose to the whole breast and primary tumor site was 5000 cGy and 6940 cGy, respectively. Median follow-up was 61 months (range 27-191 months).
  
  
  RESULTS
  Five patients (9%) failed in the breast for an 8-year actuarial local failure rate of 11%. Median time to failure was 34 months. All five patients with local recurrence underwent mastectomy and are alive, without evidence of disease at a mean of 40 months post mastectomy. The 8-year actuarial absolute and cause specific survivals were 89% and 100%, respectively. Cosmetic results were excellent or totally acceptable in 90% of patients.
  
  
  CONCLUSIONS
  Patients with ductal carcinoma in situ treated by excision and irradiation achieved acceptable local control and excellent survival and cosmetic results. Because of the long time course associated with local failure, diligent and protracted follow-up is mandatory.
authors.affiliation: Palo Alto Medical Foundation, Radiation Oncology, CA 94301.
authors.forename: G R
authors.initials: GR
authors.lastname: Ray
authors.forename: J
authors.initials: J
authors.lastname: Adelson
authors.forename: E
authors.initials: E
authors.lastname: Hayhurst
authors.forename: A
authors.initials: A
authors.lastname: Marzoni
authors.forename: D
authors.initials: D
authors.lastname: Gregg
authors.forename: M
authors.initials: M
authors.lastname: Bronk
authors.forename: J
authors.initials: J
authors.lastname: McClenathan
authors.forename: N
authors.initials: N
authors.lastname: Bitar
authors.forename: I
authors.initials: I
authors.lastname: Macio
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D016019:Survival Analysis