The Role of Radiotherapy for Patients with Ductal Carcinoma In Situ

Abstract: Some patients with ductal carcinoma in situ (those with small low-to moderate-grade tumors excised with wide margins) appear to be good candidates for treatment with surgery alone. There is no agreement on the exact features defining this subgroup, however. Radiotherapy will reduce the risk of recurrence further even in this subgroup. Other patients with uninvolved microscopic resection margins have a low risk of failure when treated with surgery and radiotherapy. Patients with involved margins may be at increased risk of recurrence even after irradiation, although data on this point are contradictory. Since salvage therapy for patients with local failure after initial breast conserving therapy is not perfect at preventing subsequent local-regional or distant recurrences, such patients might be more appropriately treated with mastectomy. The ultimate risk of dying of breast cancer is small for patients with DCIS, regardless of the initial treatment approach. Each patient's preferences must be accorded great weight in making treatment decisions. It is the duty of her physicians to inform her of the potential risks and benefits of all treatment options.