title: Therapeutic strategy for ductal carcinoma in situ patients according to Van Nuys Prognostic Index.
abstract: OBJECTIVE
  Evaluation of therapeutic strategy for Ductal Carcinoma In Situ (DCIS) patients at our Brest Cancer Centre and analysis of our pattern of treatment with respect to Van Nuys Prognostic Index (VNPI) cathegories.
  Our study population is the result of a selection of 85 DCIS patients classified according to the VNPI risk of Local Recurrence (LR). A comparison was made between treatment effectively performed and therapy suggested by VNPI protocols.
  
  
  RESULTS
  Out of 53 DCIS women (62%) at low local recurrence risk, 5 patients underwent Breast Conserving Surgery (BCS) alone, 7 were treated with mastectomy and 41 underwent BCS followed by radiotherapy (RT). Out of 31 patients (37%) belonging to VNPI intermediate risk group, 25 cases recived BCS+RT and 6 cases received mastectomy. Only one patient (1%) belonged to VNPI high risk group and underwent mastectomy.
  
  
  CONCLUSIONS
  Only 31 patients (36,5%) had their definitive treatment according to recommended VNPI criteria, but none of the other 54 cases (63,5%) was undertreated. Performing mastectomy instead of BCS or adding adjuvant radiotherapy at BCS alone were not considered overtreatment because the therapeutic strategy was the result of a multidisciplinary discussion.
  
  
  CONCLUSIONS
  As DCIS is a heterogeneus desease the one-size-fits-all approach to treatment seems inappropriate. The VNPI was developed in order to help treatment choices, but therapeutic strategies can't be based only on local recurrence risk and need a multidisciplinary approach.
  
  
  BACKGROUND
  Breast cancer, Ductal carcinoma in situ, Van Nuys Prognostic Index.
authors: Michela
authors: M
authors: Andretta
authors: Serena
authors: S
authors: Scomersi
authors: Monica
authors: M
authors: Urbani
authors: Marina
authors: M
authors: Bortul
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods; D015412:Mastectomy, Segmental / Q000379:methods; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome