title: Salvage treatment for local or local-regional recurrence after initial breast conservation treatment with radiation for ductal carcinoma in situ.
abstract: The present study evaluated the outcome of salvage treatment for women with local or local-regional recurrence after initial breast conservation treatment with radiation for mammographically detected ductal carcinoma in situ (DCIS; intraductal carcinoma) of the breast. The study cohort consisted of 90 women with local only first failure (n=85) or local-regional only first failure (n=5). The histology at the time of recurrence was invasive carcinoma for 53 patients (59%), non-invasive carcinoma for 34 patients (38%), angiosarcoma for one patient (1%), and unknown for two patients (2%). The median follow-up after salvage treatment was 5.5 years (mean=5.8 years; range=0.2-14.2 years). The 10-year rates of overall survival, cause-specific survival, and freedom from distant metastases after salvage treatment were 83%, 95%, and 91%, respectively. Adverse prognostic factors for the development of subsequent distant metastases after salvage treatment were invasive histology of the local recurrence and pathologically positive axillary lymph nodes. These results demonstrate that local and local-regional recurrences can be salvaged with high rates of survival and freedom from distant metastases. Close follow-up after initial breast conservation treatment with radiation is warranted for the early detection of potentially salvageable local and local-regional recurrences.
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA. solin@xrt.upenn.edu
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Solin
authors.forename: Alain
authors.initials: A
authors.lastname: Fourquet
authors.forename: Frank A
authors.initials: FA
authors.lastname: Vicini
authors.forename: Marie
authors.initials: M
authors.lastname: Taylor
authors.forename: Bruce
authors.initials: B
authors.lastname: Haffty
authors.forename: Eric A
authors.initials: EA
authors.lastname: Strom
authors.forename: Elaine
authors.initials: E
authors.lastname: Wai
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Pierce
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
authors.forename: Harry
authors.initials: H
authors.lastname: Bartelink
authors.forename: Francois
authors.initials: F
authors.lastname: Campana
authors.forename: Marsha D
authors.initials: MD
authors.lastname: McNeese
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Olivotto
authors.forename: Nina
authors.initials: N
authors.lastname: Bijker
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Hwang
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000601:surgery*; D011379:Prognosis; D016879:Salvage Therapy / Q000379:methods*