title: Breast conserving treatment for ductal carcinoma in situ in the elderly: can radiation therapy be avoided? Our experience.
abstract: BACKGROUND
  Ductal Carcinoma In Situ (DCIS) is a heterogeneous, pre-malignant disease accounting for 15-20% of all new breast cancers. If appropriately managed, DCIS has a small chance of impacting on patient life expectancy. Despite the possibility of a further recurrence or of a development in an invasive form, we are unable to select treatment of choice especially in the elderly. In particularly we risk an overtreatment of women at low risk of progression to invasive breast cancer. The aim of this study was to retrospectively evaluate the outcome of elderly patients affected by DCIS not undergoing Radiation Therapy (RT) after Breast Conserving Surgery (BCS).
  
  
  METHODS
  We reviewed our prospectively-maintained database from 1998 to 2013, selecting all women over 65 years old diagnosed with DCIS who did not receive RT for personal choice. We considered two groups, according to the risk of local recurrence (Low Risk (Group 1) vs. High Risk (Group 2)).
  
  
  RESULTS
  We identified 44 cases of DCIS treated with surgery alone or with surgery followed by adjuvant tamoxifen. 24 patients presented low risk of local recurrence (Group 1) and 20 had characteristics associated to high risk of local recurrence (Group 2). At a median follow-up of 66.3 months, no local recurrences have been described in group 1. No patients presented distant metastases, while 4 patients died for other causes. At a median follow-up of 72 months we observed 5 local recurrences in the second group (p < 0.05).
  
  
  CONCLUSIONS
  Our results suggest that radiation therapy can be safely avoided in a selected group of elderly patients affected by DCIS.
authors.affiliation: Breast Unit, A.O. IRCCS Arcispedale S.M.N, Via Risorgimento 80 42120 Reggio Emilia, Italy. Electronic address: giuseppe.falco@asmn.re.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Falco
authors.affiliation: Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy. Electronic address: nicola.rocco@unimi.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Rocco
authors.affiliation: Breast Unit, A.O. U. Second University of Naples, Naples, Italy. Electronic address: eugenio.procacini@unina2.it.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Procaccini
authors.affiliation: School of Medicine, Second University of Naples, Naples, Italy. Electronic address: mg.sommella@gmail.com.
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Sommella
authors.affiliation: University Polytechnic of the Marche, Ancona, Italy. Electronic address: danielebordoni@alice.it.
authors.forename: Daniele
authors.initials: D
authors.lastname: Bordoni
authors.affiliation: Breast Unit, A.O. IRCCS Arcispedale S.M.N, Via Risorgimento 80 42120 Reggio Emilia, Italy. Electronic address: eugenio.cenini@asmn.re.it.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Cenini
authors.affiliation: Breast Unit, A.O. IRCCS Arcispedale S.M.N, Via Risorgimento 80 42120 Reggio Emilia, Italy. Electronic address: fabio.castagnetti@asmn.re.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Castagnetti
authors.affiliation: Department of Advanced Biomedical Sciences - Section of Imaging, University Federico II of Naples, Italy. Electronic address: vincenzosabatino@yahoo.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Sabatino
authors.affiliation: Department of Gastroenterology, Endocrinology and Surgery, University Federico II of Naples, Naples, Italy. Electronic address: rita.compagna@libero.it.
authors.forename: Rita
authors.initials: R
authors.lastname: Compagna
authors.affiliation: Department of Gastroenterology, Endocrinology and Surgery, University Federico II of Naples, Naples, Italy. Electronic address: ga.dellacorte@gmail.com.
authors.forename: Gianni Antonio
authors.initials: GA
authors.lastname: Della Corte
authors.affiliation: Department of Gastroenterology, Endocrinology and Surgery, University Federico II of Naples, Naples, Italy. Electronic address: antonello.accurso@unina.it.
authors.forename: Antonello
authors.initials: A
authors.lastname: Accurso
authors.affiliation: Department of Gastroenterology, Endocrinology and Surgery, University Federico II of Naples, Naples, Italy. Electronic address: bramato@unina.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
authors.affiliation: Breast Unit, A.O. IRCCS Arcispedale S.M.N, Via Risorgimento 80 42120 Reggio Emilia, Italy. Electronic address: guglielmo.ferrari@asmn.re.it.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Ferrari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012306:Risk; D013629:Tamoxifen / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen
keywords: Breast cancer; Breast conserving treatment; Ductal carcinoma in situ; Radiation therapy