Abstract P3-17-07: Improved long-term outcomes of breast-conserving therapy for women with ductal carcinoma in situ
Authors: Warren LE , Chen Y-H , Halasz LM , Capuco A , Bellon JR , Brock JE , Punglia RS , Wong JS , Harris JR 
Published: March 2017

Purpose: Improved mammographic and surgical techniques and pathologic evaluation, particularly greater attention to achieving negative margins, have resulted in decreased local recurrence rates for patients with ductal carcinoma in situ (DCIS). This is an updated analysis of local outcomes after breast-conserving surgery (BCS) and adjuvant radiation therapy (RT) at a single institution in the modern era.

Methods and Materials: We retrospectively reviewed the records of 245 women treated for DCIS with BCS and RT between 2001 and 2007. Competing risk analysis was used to calculate local recurrence (LR) as a first event with the development of a second non-breast malignancy, contralateral breast cancer, and death as competing first events. The median age at diagnosis was 54 (range, 32-84) and 174 (93%) women had estrogen receptor (ER) and/or progesterone receptor (PR) positive disease. Ninety-five (39%) were grade III. Specimen radiograph during surgery was obtained for 223 women (91%) and post-operative mammogram for 102 (42%). Half underwent more than one excision. The institutional goal for margins during the study period was 3 mm or greater; final margins were &gt;2 mm in 221 (90%). All received adjuvant radiation therapy to the whole breast (median whole breast dose: 4400; range, 4000 - 5220) and nearly all (99%) received a boost to the surgical cavity (median boost dose: 1600; range, 800 – 1800). Among patients with ER and/or PR+ disease, 105 (60%) received adjuvant hormonal therapy.

Results: At a median follow-up of 10.6 years, 4 patients had a LR (2 DCIS, 2 invasive ductal carcinoma) as a first event with a cumulative LR incidence of 0.0% and 1.5% at 5 and 10 years, respectively. The 5 and 10-year cumulative incidence of the competing first events is seen in the table below. Twenty women developed a contralateral breast cancer (CBC; 8 DCIS, 12 invasive carcinoma), 13 were diagnosed with a second non-breast malignancy (3 endometrial, 2 fallopian tube, 1 gallbladder, 1 leukemia and thyroid, 4 lung, 1 ovarian, and 1 uterine), and 7 died. Family history, age at diagnosis, and receipt of hormonal therapy were not significantly associated with the development of CBC on univariable analysis (all p&gt;0.05).

Incidence of local recurrence and competing eventsEvent5-year cumulative incidence10-year cumulative incidenceLocal recurrence0.0%1.5%Contralateral Breast Cancer2.5%7.9%Second non-breast malignancy2.6%4.5%Death1.2%3.5%

Conclusions: With longer follow-up, our rates of local recurrence following breast-conserving therapy for DCIS remain very low (1.5% at 10 years). The vast majority of patients had &gt;2 mm margins, specimen radiographs, and received a tumor bed boost. The majority (60%) of patients with hormone receptor positive disease received adjuvant endocrine therapy. The 10-year incidence of CBC was higher than expected. Predisposing factors for the development of CBC are worthy of investigation.

Citation Format: Warren LE, Chen Y-H, Halasz LM, Capuco A, Bellon JR, Brock JE, Punglia RS, Wong JS, Harris JR. Improved long-term outcomes of breast-conserving therapy for women with ductal carcinoma in situ [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-17-07.