title: Margin width as a determinant of local control with and without radiation therapy for ductal carcinoma in situ (DCIS) of the breast.
abstract: In order to assess the utility of margin width in relation to other histopathologic features as a determinant of local control in ductal carcinoma in situ (DCIS) of the breast, we retrospectively examined the treatment of 109 breasts treated with (n = 54) or without adjuvant radiotherapy (n = 55). Median follow-up was 49 and 54 months for patients treated with excision alone (E) or excision plus adjuvant radiotherapy (E+XRT), respectively. Cases treated with E+XRT were significantly larger and had a trend towards closer surgical margins than those treated with E alone. For all cases, margin width < or = 1 mm and lesion diameter >15 mm were significantly associated with increased local recurrence. Lesion size < or = 15 mm was associated with no cases of local failure regardless of treatment arm. For lesions >15 mm in diameter, there was a significant decrease in 5-year local failure with E+XRT compared to E alone (21% vs. 36%, P = 0.03). Tumor margin >1 mm was associated with a low rate of 5-year local failure for either E alone or E+XRT (10.9% vs. 4.6%, P = NS). Tumor margin < = 1 mm had a high rate of local failure that was not significantly decreased by the addition of adjuvant radiotherapy. These results show that large diameter (>15 mm) and close surgical margins (< or = 1 mm) are the dominant risk factors for local recurrence in DCIS. E+XRT significantly decreased local failure risk compared to E alone for large lesions but not for those with close margins.
authors: Department of Radiation Oncology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
authors: A C
authors: AC
authors: Neuschatz
authors: T
authors: T
authors: DiPetrillo
authors: H
authors: H
authors: Safaii
authors: D
authors: D
authors: Lowther
authors: M
authors: M
authors: Landa
authors: D E
authors: DE
authors: Wazer
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000532:radiotherapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D013997:Time Factors; D016896:Treatment Outcome