[Radiotherapy of in situ carcinoma of the breast. EORTC Breast Group].
More and more breast cancers are being detected at an situ stage. Carcinoma in situ (CIS) can be divided in two categories, depending on where it arises. Ductal CIS arises in the ducts. Malignant epithelial cells are found within the ducts but there is no invasion through the basement membrane. Large tumors tend to be multicentric along the ducts resulting in underestimation of the treatment volume for tumorectomy and radiotherapy. Lobular CIS occurs in the lobules and may extend into the ducts in the same way that ductal CIS may extend into the lobules, resulting in occasional difficulty in distinguishing between the two. Preinvasive ductal carcinoma or DCIS is being diagnosed more often and now constitutes 22% of breast cancers detected by mammography. Many of these lesions are nonpalpable. Standard therapy has been total mastectomy. Breast conserving operations such as lumpectomy alone will yield a high recurrence rate of 20% and half of this will reappear as invasive cancer. DCIS is not proven to be radioresistant. The optimal dose for radiotherapy of DCIS is unknown. Recent results from an NSABP trial B17 of lumpectomy with and without radiotherapy suggested that lumpectomy with postoperative radiation therapy gave acceptable relapse free survival of 83% compared to 72% after surgery alone (p = 0.00004) and low recurrence rates of 1.9% vs 4.8%. The results of the corresponding EORTC-studies will be published in 1998.
Julien
J P
JP
Service de Chirurgie, Centre Henri Becquerel-Rouen, France.
D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D002278:Carcinoma in Situ / Q000473:pathology / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D011379:Prognosis; D011836:Radiation Tolerance; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant
Die Strahlentherapie beim In-situ-Karzinom der Brust. EORTC Breast Group.