The Management of Ductal Carcinoma In-Situ at Charing Cross Hospital


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Helen Saxby1,Hamoun Rozati1,Sami Shousa1,Susan Cleator1
1Charing Cross Hospital

Abstract

Background

Ductal carcinoma in-situ (DCIS) is a heterogeneous condition and treatment is controversial. Following breast conserving surgery (BCS) there is no consensus as to the subgroup of patients who can avoid adjuvant radiotherapy (RT).

Aim: To document the consistency of management of pure DCIS in a single institution over five years

Method

All pure DCIS cases undergoing surgery from the 01/09/10 to 01/09/15 at Charing Cross Hospital were included. The clinicopathological factors including Van Nuys Prognostic Index (VNPI), and management including type of surgery and use of radiotherapy were documented.

Results

262 patients with DCIS were identified with a median age of 58 years (range 27-86 years). 40 (15.3%) patients had low grade DCIS, 110 (42.0%) had at most intermediate grade and 112 (42.7%) had at most high grade.

115 patients (43.9%) underwent mastectomy (Mx) and 107 (40.8%) underwent sentinel node biopsy (SNB). Of those undergoing Mx, 96 (83.5%) underwent SNB. Of those undergoing BCS, 90 (61.2%) received RT. 45 patients (17.2%) underwent re-excision of margins and 21 patients (8%) underwent completion Mx.

34 (42.5%) patients with VNPI 4-6 who underwent BCS received RT. 53 (84.1%) patients with VNPI 7-9 who underwent BCS received RT. 3 (75.0%) patients with VNPI 10-12 who underwent BCS received RT.

We are aware of 7 (2.7%) patients with recurrent disease with a median time of 15 months from initial surgery; all occurred in the ipsilateral breast and were pre-invasive. 26 patients (9.9%) had a previous breast cancer; 14 (5.3%) pre-invasive and 12 (4.6%) invasive. 13 (92.9%) of pre-invasive disease was in the ipsilateral breast, 4 (33.3%) of invasive disease was in the ipsilateral breast.

Conclusion

Over the last 5 years, our unit has not withheld radiotherapy following BCS for VNPI score 4-6 demonstrating that the unit does not accept this group as truly low risk.