Impact of hormonal status on outcome of ductal carcinoma in situ treated with breast-conserving surgery plus radiotherapy: Long-term experience from two large-institutional series |
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| Affiliation: | 1. Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy;2. Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Italy;3. Breast Unit, S. Maria Annunziata Hospital, Florence, Italy;4. Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Italy;5. Struttura Complessa di Senologia Clinica, Cancer Research and Prevention Institute (ISPO), Italy;6. Department of Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy;7. Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy;1. Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, 33612, USA;2. Department of Tumor Biology, Moffitt Cancer Center, Tampa, FL, 33612, USA;3. Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, 33612, USA;1. Department of Neurosurgery, Texas Children’s Hospital/Baylor College of Medicine, 6701 Fannin Street, CCC 1230, Houston, TX 77030, USA;2. Section of Neurosurgery, Department of Surgery, University of Chicago, Chicago, IL, USA;1. Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL 60661, USA;2. Department of Neurological Surgery, The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA;1. Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;2. Northwestern Medicine Chicago Proton Center, Warrenville, IL, USA;3. Gamma Knife Center, University of Minnesota, Waconia, MN, USA;4. Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA;5. Miami Cancer Institute, Miami, FL, USA;1. Melanoma Medical Oncology and Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;2. Service de Dermatologie Générale et Oncologique, Hôpital A Paré, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France;3. Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia;1. Breast Surgery Division, European Institute of Oncology, Milano, Italy;2. Epidemiology and Biostatistics Division, European Institute of Oncology, Milano, Italy;3. Radiotherapy Division, European Institute of Oncology, Milano, Italy;4. University of Milan, European Institute of Oncology, Italy;5. Scientific Directorate, European Institute of Oncology, Milano, Italy |
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| Abstract: | BackgroundDuctal carcinoma in situ (DCIS) is a heterogeneous disease, for which the best adjuvant treatment is still uncertain. Many attempts of risk-groups stratification have been made over time, developing prognostic scores to predict risk of local recurrence (LR) on the basis of features such as age, final surgical margins (FSM) status, grade, and tumor size. The aim of our analysis was to evaluate the patterns of recurrence from a two large-institutional retrospective series.Patients and methodsWe collected data on 457 patients treated with BCS and adjuvant RT between 1990 and 2012. Final analysis was performed on 278 patients, due to missing data about hormonal status (HS). Patients were treated at the Radiation Oncology Unit of the University of Florence (n = 195), and S. Maria Annunziata Hospital (n = 83) (Florence, Italy).ResultsAt a median follow up time of 10.8 years (range 3–25), we observed 20 LR (7.2%). The 5-year and 10-year LR rates were 4.9% and 10.2%, respectively. At Cox regression univariate analysis, estrogen receptor (ER) positive status (p = 0.001), HS positive (p = 0.003), and FSM <1 mm (p = 0.0001) significantly impacted on LR. At Cox regression multivariate analysis positive ER status maintained a protective role (p = 0.003), and FSM status <1 mm its negative impact (p = 0.0001) on LR rate.ConclusionsOur experience confirmed the wide heterogeneity of DCIS. Inadequate FSM and negative ER status negatively influenced LR rates. Tumor biology should be integrated in adjuvant treatment decision-making process. |
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| Keywords: | Breast cancer Ductal carcinoma in situ Breast conserving surgery Radiotherapy Hormonal status Prognostic factors |
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