Outcome after invasive local recurrence in patients with ductal carcinoma in situ of the breast.

Silverstein, Melvin J.; Lagios, Michael D.; Martino, Silvana; Lewinsky, Bernard S.; Craig, Pamela H.; Beron, P.J.; Gamagami, Parvis; Waisman, James

doi:10.1200/jco.1998.16.4.1367

Cited by 153 publications

(84 citation statements)

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“…8 However, in recent years an attempt to maintain negative surgical margins has been made, and the results of local control for DCIS after breast-conserving therapy have shown results similar to those reported for local control in patients with invasive breast carcinoma. 9,[52][53][54] The findings of the current study indicate that achieving local tumor control is essential in breastconserving therapy. Although postoperative radiotherapy or systemic adjuvant chemotherapy and/or endocrine therapy may be a part of this treatment, sufficient surgical resection of the tumor, including reducing the risk of intraductal spread, is vital.…”

Section: Discussionmentioning

confidence: 92%

Computer‐assisted complete three‐dimensional reconstruction of the mammary ductal/lobular systems

Ohtake¹,

Kimijima²,

Fukushima³

et al. 2001

Cancer

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Section: Discussionmentioning

confidence: 92%

Computer‐assisted complete three‐dimensional reconstruction of the mammary ductal/lobular systems

Ohtake¹,

Kimijima²,

Fukushima³

et al. 2001

Cancer

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“…It is increasingly evident that for some clinical presentations, for example, the absence of necrosis, small lesion size, and negative margins, the absolute benefit of breast irradiation is small, perhaps negligibly so. Despite this, studies show that local recurrences of DCIS are not wholly salvageable [27], and so many continue to err on the side of caution given the lack of firm data. Further prospective clinical trial work must be performed to establish with a high degree of scientific certainty the relative prognostic value of specific clinical and histopathologic variables such as age, tumor size, grade, and margin width.…”

Section: Discussionmentioning

confidence: 99%

Margin width as a determinant of local control with and without radiation therapy for ductal carcinoma in situ (DCIS) of the breast

et al. 2001

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SUMMARY In order to assess the utility of margin width in relation to other histopathologic features as a determinant of local control in ductal carcinoma in situ (DCIS) of the breast, we retrospectively examined the treatment of 109 breasts treated with (n ‫؍‬ 54) or without adjuvant radiotherapy (n ‫؍‬ 55). Median follow-up was 49 and 54 months for patients treated with excision alone (E) or excision plus adjuvant radiotherapy (E؉XRT), respectively. Cases treated with E؉XRT were significantly larger and had a trend towards closer surgical margins than those treated with E alone. For all cases, margin width <1 mm and lesion diameter >15 mm were significantly associated with increased local recurrence. Lesion size <15 mm was associated with no cases of local failure regardless of treatment arm. For lesions >15 mm in diameter, there was a significant decrease in 5-year local failure with E؉XRT compared to E alone (21% vs. 36%, P ‫؍‬ 0.03). Tumor margin >1 mm was associated with a low rate of 5-year local failure for either E alone or E؉XRT (10.9% vs. 4.6%, P ‫؍‬ NS). Tumor margin <1 mm had a high rate of local failure that was not significantly decreased by the addition of adjuvant radiotherapy. These results show that large diameter (>15mm) and close surgical margins (<1 mm) are the dominant risk factors for local recurrence in DCIS. E؉XRT significantly decreased local failure risk compared to E alone for large lesions but not for those with close margins.

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“…5 The Kaplan-Meier plots in our paper may change with additional follow-up, but it is unlikely that the patterns will be significantly altered.…”

Section: Treatment Of Ductal Carcinoma In Situmentioning

confidence: 99%

“…The incidence of serious infections after liposuction is probably very low; rates ranging from 0.02 percent to 0.34 percent have been reported for all infections attributed to the procedure. 5 To the Editor: Rao et al omitted hemorrhage from their differential diagnosis. Liposuction may be considered analogous to a blunt-type traumatic injury, but penetrating injury to major structures can occur if the suction cannula enters a deep tissue plane.…”

Section: Treatment Of Ductal Carcinoma In Situmentioning

confidence: 99%

Trouble from a Literary Reference

Fischer¹

1999

N Engl J Med

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Our fax numbers: 617-739-9864 and 617-734-4457Our e-mail address: letters@nejm.orgWe cannot acknowledge receipt of your letter, but we will notify you when we have made a decision about publication. We are unable to provide prepublication proofs. Please enclose a stamped, self-addressed envelope if you want unpublished material returned to you. Financial associations or other possible conflicts of interest must be disclosed. Submission of a letter constitutes permission for the Massachusetts Medical Society, its licensees, and its assignees to use it in the Journal' s various editions (print, data base, and optical disk) and in anthologies, revisions, and any other form or medium.998 · S eptember 23, 19 9 9The New Eng land Jour nal of Medicine Correspondence Treatment of Ductal Carcinoma in SituTo the Editor: The article by Silverstein et al. (May 13 issue) 1 on the influence of margin width on local recurrence in patients with ductal carcinoma in situ who were treated with breast-conserving therapy provides no data showing that margins (of any size) were associated with outcome in their patients. The authors define subgroups of patients according to margin width without ever proving that margins were statistically important in univariate or multivariate analysis. We are left to guess whether margins were related to outcome as a continuous variable and how the three subgroups of patients (defined according to margin width) were selected. Instead, the "multivariate analysis" examines only two variables at a time: the use of radiation therapy and one other prognostic variable within each of the three margin-width subgroups. Without a multivariate analysis that simultaneously includes all the variables that might be related to local recurrence, we can only speculate whether the authors have analyzed their results incorrectly or whether their conclusions are biased.It is also unclear why we are not given information on the length of follow-up in the subgroups of patients defined according to margin width. Since patients treated after 1989 generally did not receive radiation therapy and the extent of resection appears to have increased after this date, it is only logical to assume that follow-up may be substantially shorter for patients with large margins who did not receive radiation therapy. In fact, we are told that patients who received radiation therapy had almost 2 more years of follow-up than patients who underwent only excision: 92 as compared with 72 months, respectively.In patients treated with breast-conserving therapy, two types of recurrences can develop, which are biologically unrelated. They are a recurrence of the treated index lesion and independent development of a separate cancer elsewhere in the breast. If these two events are then combined and analyses are performed, the dilutional effect of these unrelated new cancers may obscure possible statistical associations. 2 Finally, the suggestion that patients with margins from 1 to less than 10 mm wide are a homogeneous group who will respond uniforml...

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Outcome after invasive local recurrence in patients with ductal carcinoma in situ of the breast.

Cited by 153 publications

References 20 publications

Computer‐assisted complete three‐dimensional reconstruction of the mammary ductal/lobular systems

Computer‐assisted complete three‐dimensional reconstruction of the mammary ductal/lobular systems

Margin width as a determinant of local control with and without radiation therapy for ductal carcinoma in situ (DCIS) of the breast

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