The influence of margin width and volume of disease near margin on benefit of radiation therapy for women with DCIS treated with breast-conserving therapy Journal Article


Authors: Rudloff, U.; Brogi, E.; Reiner, A. S.; Goldberg, J. I.; Brockway, J. P.; Wynveen, C. A.; McCormick, B.; Patil, S.; Van Zee, K. J.
Article Title: The influence of margin width and volume of disease near margin on benefit of radiation therapy for women with DCIS treated with breast-conserving therapy
Abstract: Objective and summary background data: There remains variation in the use of radiation therapy (RT) in women with ductal carcinoma in situ (DCIS), despite prospective randomized trials documenting its benefit in reducing the risk of ipsilateral breast tumor recurrence (IBTR). Methods: Patients with DCIS treated with excision alone or excision plus RT from 1991 to 1995 were identified. Margin width, number of involved ducts at closest margin, age, presence of palpable mass, presence of lobular neoplasia, nuclear grade, and necrosis were tested in uni-and multivariate analysis for association with risk of IBTR and added value of RT. RESULTS: Two hundred ninety-four patients with a median follow-up of 11 years had actuarial 10-and 15-year overall IBTR rates of 22% and 29%, respectively. For lesions excised with margins of <1 mm, 1 to 9 mm, and ≥10 mm, the actuarial 10-year IBTR rates were 28%, 21%, and 19%, respectively. RT reduced adjusted IBTR rates by 62% (P = 0.002) for all patients; 83% for lesions with <1 mm margins (P = 0.002), 70% for 1 to 9 mm (P = 0.05), and 24% (P = 0.55) for ≥10 mm. After adjustment for other variables, higher volume of disease near the margin was associated with risk of IBTR in the no RT group (HR = 3.37, P = 0.002) and greater benefit of RT (HR 0.14; P = 0.004). Conclusion: Effect of RT on IBTR risk is influenced by both margin width and number of involved ducts at nearest margin. Patients with higher volume of disease near the margin derive a greater benefit from the addition of RT. Despite margins of ≥10 mm, the risk of IBTR remains substantial in patients with DCIS. Copyright © 2010 by Lippincott Williams & Wilkins.
Keywords: adult; controlled study; middle aged; cancer surgery; survival rate; major clinical study; cancer radiotherapy; radiotherapy, adjuvant; follow up; cancer grading; neoplasm recurrence, local; breast neoplasms; risk assessment; tamoxifen; lung carcinoma; therapy effect; intraductal carcinoma; carcinoma, intraductal, noninfiltrating; mastectomy, segmental; breast necrosis; raloxifene
Journal Title: Annals of Surgery
Volume: 251
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2010-01-01
Start Page: 583
End Page: 591
Language: English
DOI: 10.1097/SLA.0b013e3181b5931e
PUBMED: 20224381
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: ANSUA" - "Source: Scopus"
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MSK Authors
  1. Sujata Patil
    511 Patil
  2. Anne S Reiner
    250 Reiner
  3. Kimberly J Van Zee
    293 Van Zee
  4. Udo Rudloff
    12 Rudloff
  5. Edi Brogi
    517 Brogi
  6. Beryl McCormick
    372 McCormick
  7. Christine Ann Wynveen
    11 Wynveen