Ductal Carcinoma in Situ of the Breast

BACKGROUND: The treatment of ductal carcinoma in situ of the breast (DCIS) has changed dramatically during the last decade. MATERIAL AND METHODS: In a review article, prospective randomized and retrospective studies of different treatment options of DCIS are evaluated to define the new role of radiotherapy. RESULTS: Until a few years ago, total mastectomy was the standard treatment of DCIS achieving a 95-98% cure rate. Three randomized studies show that adjuvant radiotherapy following local excision significantly reduces the rate of invasive and noninvasive recurrences by 40-60%, thus making breast conservation possible. Retrospective studies evaluated prognostic factors (tumor size; age; margin width, presence of necrosis; grading) in order to define subgroups of patients whom adjuvant radiotherapy can be safely spared. Adequately excised tumors with favorable grading and not associated with necrosis are potential candidates. Further evaluation in prospective randomized studies is, however, required. CONCLUSIONS: Radiotherapy is an essential part of breast-conserving treatment of DCIS to achieve sufficient local control.