title: Breast-conserving treatment for ductal carcinoma in situ: Impact of boost and tamoxifen on local recurrences.
abstract: OBJECTIVE
  Ductal carcinoma in situ represents 15 to 20% of all breast cancers. Breast-conserving surgery and whole breast irradiation was performed in about 60% of the cases. This study reports local recurrence rates in patients with ductal carcinoma in situ treated by breast-conserving surgery and whole breast irradiation with or without boost and/or tamoxifen and compares different therapeutic options in two European countries.
  
  
  METHODS
  From 1998 to 2007, 819 patients with pure ductal carcinoma in situ were collected, both in France (266) and Italy (553). Median age was 56. All underwent breast-conserving surgery and whole breast irradiation; 391 (48%) received a boost (55% in France and 45% in Italy, P=0.017) and 173 (22.5%) tamoxifen (4.5% in France and 32% in Italy, P<0.0001).
  
  
  RESULTS
  With a 90-month median follow-up, there were 51 local recurrences (6.2%), including 27 invasive (53%). The 5- and 10-year local recurrence rates were 4% and 8.6%. Two patients developed axillary recurrence and 12 (1.5%) metastases (seven after invasive local recurrence); 41 (5%) patients had contralateral breast cancer. In the multivariate analysis, high nuclear grade and lack of tamoxifen are the most powerful predictors of local recurrence, with 2.6 (95% confidence interval [95% CI]: 1.74-3.89, P=0.0012) and 2.85 (95% CI: 1.42-5.72, P=0.04) odds ratio (OR) estimates, respectively. Age, margin status and boost did not influence local recurrence rates.
  
  
  CONCLUSIONS
  This study confirms the ductal carcinoma in situ treatment heterogeneity among countries and the unfavourable prognostic role of nuclear grade. Tamoxifen reduces local recurrence rates and might be considered for some subgroups of patients, but further confirmation is required. The boost usefulness still remains unclear.
authors.affiliation: Institut du cancer Courlancy, 38, rue de Courlancy, 51100 Reims, France. Electronic address: bcutuli@iccreims.fr.
authors.forename: B
authors.initials: B
authors.lastname: Cutuli
authors.affiliation: Centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21000 Dijon, France.
authors.forename: N
authors.initials: N
authors.lastname: Wiezzane
authors.affiliation: Radiation Oncology Section, University and General Hospital of Perugia, Perugia, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Palumbo
authors.affiliation: Policlinico di Modena, Modena, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Barbieri
authors.affiliation: Azienda Ospedaliera Universitaria, Genova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Guenzi
authors.affiliation: Fondazione Poliambulanza, Brescia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Huscher
authors.affiliation: Ospedale San Donato, Arezzo, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Borghesi
authors.affiliation: Sylia-Stat, Bourg-la-Reine, France.
authors.forename: C
authors.initials: C
authors.lastname: Delva
authors.affiliation: Ospedale San Martino, Belluno, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Iannone
authors.affiliation: Institut du cancer Courlancy, 38, rue de Courlancy, 51100 Reims, France; Ospedale SS San Giovanni e Paolo, Venezia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Vianello
authors.affiliation: Ospedale Belcolle, Viterbo, Italy.
authors.forename: M-E
authors.initials: ME
authors.lastname: Rosetto
authors.affiliation: Radiation Oncology Section, University and General Hospital of Perugia, Perugia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Aristei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007558:Italy; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen
keywords: Boost; Breast-conserving therapy; CCIS; Carcinome canalaire in situ; Chirurgie conservatrice; DCIS; Grade nucléaire; Local recurrence; Nuclear grade; Récidive locale; Tamoxifen; Tamoxifène; Traitement; Treatment