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Cutuli B. [Ductal carcinoma in situ in 2019: Diagnosis, treatment, prognosis]. Presse Med 2019; 48:1112-1122. [PMID: 31653542 DOI: 10.1016/j.lpm.2019.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 08/28/2019] [Indexed: 12/27/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) currently represents up to 15% of the newly diagnosed breast cancers, and are almost always detected by microcalcifications. Global prognosis is good (3% of 15-year specific mortality) but invasive local recurrences (LR) can lead to metastasis in 12-15% of the cases. Breast conserving surgery with whole breast irradiation is the main treatment (reducing LR by 50%), but mastectomy (with or without reconstruction) is performed in about 30% of the cases due to wide lesion size and/or multicentricity. The role of tamoxifen remains unclear. Axillary dissection is needless but sentinel node biopsy is proposed in case of micro-invasion suspicion (large lesions with high grade). The main factors of LR are young age (≤40 years) incomplete excision, and high nuclear grade with comedonecrosis. Several studies on "therapeutic descalation" are still ongoing in order to identify the "low risk" DCIS (about 10% of the cases) in which radiotherapy could be safely omitted.
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MESH Headings
- Age Factors
- Antineoplastic Agents, Hormonal/therapeutic use
- Biopsy
- Breast/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/etiology
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/etiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Combined Modality Therapy/methods
- Conservative Treatment
- Diagnostic Imaging/methods
- Female
- Humans
- Lymph Node Excision/trends
- Mastectomy
- Neoplasm Recurrence, Local/diagnosis
- Prognosis
- Radiotherapy
- Risk Factors
- Tamoxifen/therapeutic use
- Time Factors
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Affiliation(s)
- Bruno Cutuli
- Institut du cancer Courlancy Reims, 38, rue du Courlancy, 51100 Reims, France.
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Lhenaff M, Tunon de Lara C, Fournier M, Charitansky H, Brouste V, Mathoulin-Pelissier S, Pinsolles V, Rousvoal A, Bussieres E, Chassaigne F, Croce S, Ben Rejeb H, MacGrogan G. A single-center study on total mastectomy versus skin-sparing mastectomy in case of pure ductal carcinoma in situ of the breast. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:950-955. [PMID: 30683448 DOI: 10.1016/j.ejso.2019.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 12/17/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Ductal carcinoma in situ (DCIS) accounts for 15% of all breast cancers and generally, the prognosis is good if treated optimally. The standard treatment includes breast conservative surgery along with adjuvant radiotherapy. Skin-sparing mastectomy (SSM) preserves the breast skin envelope but its oncological safety poses a few concerns. Moreover, no DCIS-specific studies have compared the local recurrence (LR) rate following total mastectomy (TM) or SSM. We evaluated the LR rate in DCIS patients who underwent either TM or SSM. METHODS This is a retrospective study on women who underwent mastectomy with or without immediate breast reconstruction or secondary reconstruction for pure DCIS of the breast. All patients treated at Institut Bergonié by mastectomy for DCIS from January 1990 to December 2010 were included. LR and overall survival (OS) rates were estimated. RESULTS The study population included 399 patients who were categorized into two groups, 207 in the TM group and 192 in the SSM group. At 10 years of follow-up, the LR rate was 0.97% in the TM group and 1.04% in the SSM group (p = NS). The OS of the entire population was 94.7% [95% CI; 91.6-96.7], 92.8% [95% CI, 87.9-95.8] for the TM group and 96.8% [95% CI, 91.6-98.8] for the SSM group. CONCLUSIONS In our study, the LR rate following mastectomy is low, regardless of the surgical technique used, with an excellent OS at 10 years.
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Affiliation(s)
- Margaux Lhenaff
- Université de Bordeaux, 351 Cours de la Liberation, 33400, Talence, France
| | | | - Marion Fournier
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Surgery, France
| | - Hélène Charitansky
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Surgery, France
| | - Véronique Brouste
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Biostatistics, France
| | - Simone Mathoulin-Pelissier
- Université de Bordeaux, 351 Cours de la Liberation, 33400, Talence, France; Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Biostatistics, France
| | - Vincent Pinsolles
- Université de Bordeaux, 351 Cours de la Liberation, 33400, Talence, France
| | - Aurelien Rousvoal
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Surgery, France
| | - Emmanuel Bussieres
- Université de Bordeaux, 351 Cours de la Liberation, 33400, Talence, France; Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Surgery, France
| | - Florence Chassaigne
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Pathology, France
| | - Sabrina Croce
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Pathology, France
| | - Houda Ben Rejeb
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Pathology, France
| | - Gaétan MacGrogan
- Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, Department of Pathology, France
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Prise en charge des carcinomes mammaires in situ : surtraitement ? Peut-on faire moins ? IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lefeuvre D, Le Bihan-Benjamin C, Pauporté I, Medioni J, Bousquet PJ. French Medico-Administrative Data to Identify the Care Pathways of Women With Breast Cancer. Clin Breast Cancer 2017; 17:e191-e197. [PMID: 28237608 DOI: 10.1016/j.clbc.2017.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Study of the care pathways is an important topic for care planning, as well as to observe guidelines application. This study aimed to describe care pathways and the period of time between treatments of women with breast cancer (BC), at a population level. MATERIALS AND METHODS Women with in situ, local and regional BC who were hospitalized and newly treated in 2012 were included and followed for 1 year. Care pathways were described, focusing on surgery (partial mastectomy [PM], total mastectomy [TM]), chemotherapy, and radiotherapy. The periods of time between treatments were measured and compared with the guidelines. RESULTS The study involved 52,128 women. The most common care pathways among the 2845 women with in situ BC were PM-radiotherapy (46.7%) and TM (28.5%). Among the 41,470 women with local BC, they were: PM-radiotherapy (44.8%) or PM-chemotherapy-radiotherapy (16.0%). The 7813 women with regional BC had similar care pathways, although chemotherapy was given more frequently (73%). The periods of time between surgery and chemotherapy were in accordance with the guidelines for 98% of the women; those between surgery and radiotherapy were affected by adjuvant chemotherapy. Finally, the time between chemotherapy and radiotherapy was longer than recommended for 40% of the women. CONCLUSION The French medicoadministrative databases allow the study, at a national population level, of the care pathways and periods of time between treatments of women with BC according to the stage of the disease. They were close to the guidelines, although an improvement is highly necessary.
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Affiliation(s)
- Delphine Lefeuvre
- Observation, Survey and Assessment Department, Institut National du Cancer, Boulogne-Billancourt, France.
| | | | - Iris Pauporté
- Clinical Trial Department, Institut National du Cancer, Boulogne-Billancourt, France
| | - Jacques Medioni
- Paris Descartes University, Paris, France; Medical Oncology Department, Georges Pompidou European Hospital, Paris, France
| | - Philippe-Jean Bousquet
- Observation, Survey and Assessment Department, Institut National du Cancer, Boulogne-Billancourt, France
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Bauwens J, Azaïs H, Devouge P, Phalippou J, Boulanger L, Collinet P. Place de l’oncoplastie dans la prise en charge des carcinomes canalaires in situ. ACTA ACUST UNITED AC 2015; 43:735-9. [DOI: 10.1016/j.gyobfe.2015.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
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Modesto A, Gandy C, Mery E, Filleron T, Massabeau C, Izar F, Charitansky H, Roché H, de Lafontan B. [Breast ductal carcinoma in situ with microinvasion: pathological review and clinical implications]. Cancer Radiother 2014; 18:107-10. [PMID: 24637020 DOI: 10.1016/j.canrad.2013.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/09/2013] [Accepted: 12/23/2013] [Indexed: 01/12/2023]
Abstract
PURPOSE Recent improvements in the detection of breast cancer at an early stage have resulted in a rising incidence of breast ductal carcinoma in situ with microinvasion. So far, there is no consensus regarding its optimal management. We hereby report on our 10-year single institutional experience in breast ductal carcinoma in situ with microinvasion including pathological reviewing. PATIENTS AND METHODS All consecutive patients treated for a ductal carcinoma in situ with microinvasion at the Institut Claudius-Regaud (Toulouse, France) over a 10-year period were included in this study. We reviewed all available histological materials. RESULTS Sixty-three patients were eligible for this study. Two patients presented with a lymph node invasion at diagnosis. Each patient benefited from initial surgical management, which consisted either in mastectomy (n=25) or conservative resection (n=37). Axillary exploration was performed in 52 patients (82%). After a median follow-up of 61.3 months [46.9;69], the 5-year overall survival and disease free survival were 98.2 (95% CI=[88.2;99.7]) and 89.5% (95% CI=[76.3;95.6]) respectively. Two delayed invasive relapses occurred leading to one specific death. The pathological review highlighted a trend towards a loss of HR and HER2 expression (9%) in the microinvasive component in comparison with its surrounded in situ carcinoma. CONCLUSION The risk of initial lymph node involvement and delayed invasive local relapse deserve an optimal locoregional management including lymph node evaluation. The non-negligible discrepancy's rate between in situ and microinvasive components justifies HR status and HER2 expression assessment on the microinvasive component.
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Affiliation(s)
- A Modesto
- Département de radiothérapie, institut Claudius-Regaud, 20-24, rue du Pont-Saint-Pierre, 31000 Toulouse, France.
| | - C Gandy
- Département d'oncologie médicale, institut Claudius-Regaud, 20-24, rue du Pont-Saint-Pierre, 31000 Toulouse, France
| | - E Mery
- Département d'anatomie pathologie, institut Claudius-Regaud, 20-24, rue du Pont-Saint-Pierre, 31000 Toulouse, France
| | - T Filleron
- Département de statistiques médicales, institut Claudius-Regaud, 20-24, rue du Pont-Saint-Pierre, 31000 Toulouse, France
| | - C Massabeau
- Département de radiothérapie, institut Claudius-Regaud, 20-24, rue du Pont-Saint-Pierre, 31000 Toulouse, France
| | - F Izar
- Département de radiothérapie, institut Claudius-Regaud, 20-24, rue du Pont-Saint-Pierre, 31000 Toulouse, France
| | - H Charitansky
- Département de chirurgie, institut Claudius-Regaud, 20-24, rue du Pont-Saint-Pierre, 31000 Toulouse, France
| | - H Roché
- Département d'oncologie médicale, institut Claudius-Regaud, 20-24, rue du Pont-Saint-Pierre, 31000 Toulouse, France
| | - B de Lafontan
- Département de radiothérapie, institut Claudius-Regaud, 20-24, rue du Pont-Saint-Pierre, 31000 Toulouse, France
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Reprise chirurgicale des carcinomes canalaires in situ pour exérèse non in sano : existe-t-il des facteurs de risque ? ACTA ACUST UNITED AC 2013; 41:228-34. [DOI: 10.1016/j.gyobfe.2013.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 02/21/2013] [Indexed: 11/20/2022]
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Vidali C, Caffo O, Aristei C, Bertoni F, Bonetta A, Guenzi M, Iotti C, Leonardi MC, Mussari S, Neri S, Pietta N. Conservative treatment of breast ductal carcinoma in situ: results of an Italian multi-institutional retrospective study. Radiat Oncol 2012; 7:177. [PMID: 23098066 PMCID: PMC3573934 DOI: 10.1186/1748-717x-7-177] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 10/21/2012] [Indexed: 12/21/2022] Open
Abstract
Background The incidence of ductal carcinoma in situ (DCIS) has increased markedly in recent decades. In the past, mastectomy was the primary treatment for patients with DCIS, but as with invasive cancer, breast-conserving surgery followed by radiation therapy (RT) has become the standard approach. We present the final results of a multi-institutional retrospective study of an Italian Radiation Oncology Group for the study of conservative treatment of DCIS, characterized by a very long period of accrual, from February 1985 to March 2000, and a median follow-up longer than 11 years. Methods A collaborative multi-institutional study was conducted in Italy in 10 Radiation Oncology Departments. A consecutive series of 586 women with DCIS histologically confirmed, treated between February 1985 and March 2000, was retrospectively evaluated. Median age at diagnosis was 55 years (range: 29–84); 32 patients were 40 years old or younger. All women underwent conservative surgery followed by whole breast RT. Irradiation was delivered to the entire breast, for a median total dose of 50 Gy; the tumour bed was boosted in 295 cases (50%) at a median dose of 10 Gy. Results After a median follow-up of 136 months (range: 16–292 months), 59/586 patients (10%) experienced a local recurrence: invasive in 37 cases, intraductal in 20 and not specified in two. Salvage mastectomy was the treatment of choice in 46 recurrent patients; conservative surgery in 10 and it was unknown in three patients. The incidence of local recurrence was significantly higher in women younger than 40 years (31.3%) (p= 0.0009). Five patients developed distant metastases. Furthermore 40 patients developed a contralateral breast cancer and 31 a second primary tumour in a different site. The 10-year actuarial overall survival (OS) was 95.5% and the 10-year actuarial disease-specific survival (DSS) was 99%. Conclusions Our results are consistent with those reported in the literature. In particular it has been defined the importance of young age (40 years or less) as a relevant risk factor for local recurrence. This retrospective multi-institutional Italian study confirms the long term efficacy of breast conserving surgery with RT in women with DCIS.
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Affiliation(s)
- Cristiana Vidali
- S.C. Radioterapia Oncologica, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Pietà 19, 34139, Trieste, Italy.
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Cutuli B. [Radiotherapy for breast cancer: which strategy in 2012?]. Cancer Radiother 2012; 16:493-502. [PMID: 22925489 DOI: 10.1016/j.canrad.2012.07.185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 07/25/2012] [Indexed: 10/28/2022]
Abstract
Postoperative radiotherapy remains essential in breast cancer in 2012. After conserving surgery, it reduces local recurrence risks from 50 to 70%, both for ductal carcinoma in situ and invasive cancers. This was confirmed in several randomized trials and three meta-analyses. The boost increases local control in invasive cancers, but its role should be better defined in ductal carcinoma in situ. Among the latter, there is no clearly identified subgroup for which radiotherapy could be avoided. Local recurrence risk factors are now well-identified both for ductal carcinoma in situ and invasive cancers, with an inclusion, for the latter, of new molecular subgroups. After mastectomy, radiotherapy reduces local recurrence rates from 60 to 70%, especially among patients with axillary nodal involvement, with, in parallel, a 7 to 9% increased survival rate. In order to reduce the waiting list and to avoid under treatment, especially in the elderly, several hypofractionated radiotherapy schemes have been developed for several years. Three randomized trials confirmed similar results to classical radiotherapy. For ten years, several techniques of partial breast irradiation have been developed, with various doses and treated volumes. The optimal indications should be defined according to the new international guidelines.
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Affiliation(s)
- B Cutuli
- Institut du cancer Courlancy radiothérapie-oncologie, Reims, France.
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Cutuli B. Cancers canalaires in situ de moins de 5mm : Pour la radiothérapie postopératoire. ACTA ACUST UNITED AC 2012; 40:384-6. [DOI: 10.1016/j.gyobfe.2012.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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