Evaluation of Surgical and Systemic Treatment Results in Patients with Ductal Carcinoma In Situ

Year 2021, Volume: 11 Issue: 3, 417 - 422, 24.05.2021

Abdullah Durhan , Marlen Süleyman , Koray Koşmaz , Abdullah Şenlikci , Ender Ergüder , Yusuf Murat Bağ , Mevlüt Recep Pekcici , Serap Erel

https://doi.org/10.16899/jcm.898919

Abstract

Objective: The aim of this study was to evaluate the surgical method and systemic treatment results, recurrence, and mortality rates in patients whose histopathological results were ductal carcinoma in situ (DCIS) following breast surgery in our general surgery clinic.
Methods: A retrospective review was made of the preoperative and postoperative histopathological results of all patients who underwent breast surgery in our general surgery clinic between January 2016 and January 2021. The demographic data, clinicopathological features, postoperative systemic treatments, local recurrence (LR) rate, and overall survival (OS) rate of patients whose histopathological results were reported as DCIS were obtained from the data system of our hospital and the national death reporting system.
Results: The study group consisted of 24 female patients with a histopathology result of DCIS. The average age of the patients was 49.96 ± 10.61 years. In the localization of the lesions in the breast, 11 (45.8%) were observed as unifocal, 7 (29.2%) as multifocal, and 6 (25%) as multicentric. The most common type of operation was lumpectomy (n = 16, 66.7%). Sentinel lymph node biopsy was performed in 8 patients. The mean follow-up period of the patients after surgery was 32.20 ± 18.22 months. Anti-estrogen hormone therapy (HT) was applied to 21 (87.5%) patients and radiotherapy (RT) to 14 (58.3%) after the operation. There was no recurrence in any of the patients and no mortality was observed.
Conclusion: With a multidisciplinary approach and good preoperative staging, as applied in our general surgery clinic, it can be recommended that the most appropriate surgical method is applied, and risk factors determined for DCIS patients. RT is recommended for eligible patients after BCS and HT in estrogen receptor+ patients.

Keywords

Ductal carcinoma in situ, lumpectomy, mastectomy, sentinel biopsy, radiotherapy, hormone therapy

Duktal Karsinoma In Situ Tanılı Hastalarda Cerrahi ve Sistemik Tedavi Sonuçlarının Değerlendirilmesi

Abstract

Amaç: Bu çalışmada genel cerrahi kliniğimizde meme cerrahisi yapılan hastalarda histopatolojik sonucu duktal karsinoma in situ (DKİS) gelen hastalarımızın cerrahi yöntem ve sistemik tedavi sonuçlarını, rekürens ve mortalite oranlarını değerlendirmeyi amaçladık .
Yöntem: Ocak 2016 ile Ocak 2021 tarihleri arasında, genel cerrahi kliniğiniğimizde meme cerrahisi geçiren tüm hastaların preoperatif ve postoperatif histopatolojik sonuçları incelendi. Histopatolojik sonucu DKİS gelen hastaların demografik verileri, klinikopatolojik özellikleri, reoperasyon sayısı, postoperatif radyoterapi (RT), anti-östrojen hormon tedavisi (HT), lokal rekürens (LR) oranı, ve genel sağkalım (GS) oranı hastanemiz veri datasından ve ulusal ölüm bildirim sisteminden retrospektif olarak incelendi.
Bulgular: Çalışma grubu histopaptolojk sonucu DKİS gelen toplam 24 kadın hastadan oluşmakta idi. Grubun ortalama yaşı 49,96 ± 10,61’dir. Lezyonların meme içinde yerleşiminde, 11 (45,8%) ‘ i tek odaklı, 7 (%29,2) ‘si multifocal ve 6 (%25)’ sı ise multisentrik olarak gözlenmiştir. En sık uygulanan operasyon tipi lumpektomidir (n=16, 66,7%). 8 hastaya sentinel lenf nodu biyopsisi yapılmıştır. Ortanca tümör boyutu 12,5 (4-70) mm’dir. En sık görülen moleküler tip Luminal A’ dır (n=14, 58,3%). Lezyona en yakın cerrahi sınır uzaklığı ortanca 5 (0-20) mm’dir. Hastaların cerrahi sonrası ortalama takip süresi 32,20 ± 18,22 aydır. Hastaların 87,5%’si (n=21) operasyon sonrası HT ve 58,3%’ü (n=14) RT almıştır. Hastaların hiçbirinde nüks gelişmemiştir ve mortalite gözlenmedi.
Sonuç: Genel cerrahi kliniğimiz olarak multidisipliner yaklaşım ve iyi bir preoperatif evreleme ile DKİS hastalarına en uygun cerrahi yöntemi ve risk faktörlerini de değerlendirerek uygun hastalarda meme koruyucu cerrahi sonrası RT ve Östrojen reseptörü+ hastalarda HT ‘ yi öneriyoruz.

Keywords

Duktal karsinoma in situ, lumpektomi, mastektomi, sentinel biyopsi, radyoterapi, hormon tedavisi

References

• 1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
• 2. DeSantis CE, Ma J, Goding Sauer A, et al. Breast cancer statistics, 2017, racial disparity in mortality by state. CA Cancer J Clin. 2017;67(6):439-48.
• 3. Elshof LE, Schmidt MK, Rutgers EJT, et al. Cause-specific Mortality in a Population-based Cohort of 9799 Women Treated for Ductal Carcinoma In Situ. Ann Surg. 2018;267(5):952-8.
• 4. Hong YK, McMasters KM, Egger ME, et al. Ductal carcinoma in situ current trends, controversies, and review of literature. Am J Surg. 2018;216(5):998-1003.
• 5. Vatovec C, Erten MZ, Kolodinsky J, et al. Ductal carcinoma in situ: a brief review of treatment variation and impacts on patients and society. Critical reviews in eukaryotic gene expression. 2014;24(4):281-6.
• 6. Sprague BL, McLaughlin V, Hampton JM, et al. Disease-free survival by treatment after a DCIS diagnosis in a population-based cohort study. Breast cancer research and treatment. 2013;141(1):145-54.
• 7. Scoggins ME, Fox PS, Kuerer HM, et al. Correlation between sonographic findings and clinicopathologic and biologic features of pure ductal carcinoma in situ in 691 patients. AJR American journal of roentgenology. 2015;204(4):878-88.
• 8. Barreau B, Mascarel Id, Feuga C, et al. Mammography of ductal carcinoma in situ of the breast: Review of 909 cases with radiographic–pathologic correlations. European Journal of Radiology. 2005;54(1):55-61.
• 9. Lambert K, Patani N, Mokbel K. Ductal Carcinoma <i>In Situ</i>: Recent Advances and Future Prospects. International Journal of Surgical Oncology. 2012;2012:347385.
• 10. Menell JH, Morris EA, Dershaw DD, et al. Determination of the Presence and Extent of Pure Ductal Carcinoma in Situ by Mammography and Magnetic Resonance Imaging. The Breast Journal. 2005;11(6):382-90.
• 11. Allegra CJ, Aberle DR, Ganschow P, et al. National Institutes of Health State-of-the-Science Conference statement: Diagnosis and Management of Ductal Carcinoma In Situ September 22-24, 2009. Journal of the National Cancer Institute. 2010;102(3):161-9.
• 12. Kuhl CK, Schrading S, Bieling HB, et al. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 2007;370(9586):485-92.
• 13. Schouten van der Velden AP, Schlooz-Vries MS, et al. Magnetic resonance imaging of ductal carcinoma in situ: what is its clinical application? A review. Am J Surg. 2009;198(2):262-9.
• 14. Elmore JG, Longton GM, Carney PA, et al. Diagnostic concordance among pathologists interpreting breast biopsy specimens. Jama. 2015;313(11):1122-32.
• 15. Kerlikowske K, Molinaro A, Cha I, et al. Characteristics Associated With Recurrence Among Women With Ductal Carcinoma In Situ Treated by Lumpectomy. JNCI: Journal of the National Cancer Institute. 2003;95(22):1692-702.
• 16. Vicini FA, Recht A. Age at Diagnosis and Outcome for Women With Ductal Carcinoma-In-Situ of the Breast: A Critical Review of the Literature. Journal of Clinical Oncology. 2002;20(11):2736-44.
• 17. Provenzano E, Hopper JL, Giles GG, et al. Biological markers that predict clinical recurrence in ductal carcinoma in situ of the breast. Eur J Cancer. 2003;39(5):622-30.
• 18. Silverstein MJ, Lagios MD, Craig PH, et al. A prognostic index for ductal carcinoma in situ of the breast. Cancer. 1996;77(11):2267-74.
• 19. Rudloff U, Jacks LM, Goldberg JI, et al. Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol. 2010;28(23):3762-9.
• 20. Solin LJ, Gray R, Baehner FL, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. Journal of the National Cancer Institute. 2013;105(10):701-10.
• 21. Boyages J, Delaney G, Taylor R. Predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Cancer. 1999;85(3):616-28.
• 22. Tokin C, Weiss A, Wang-Rodriguez J, et al. Oncologic Safety of Skin-Sparing and Nipple-Sparing Mastectomy: A Discussion and Review of the Literature. International journal of surgical oncology. 2012;2012:921821.
• 23. Giuliano AE, Ballman KV, McCall L, et al. Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. Jama. 2017;318(10):918-26.
• 24. Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol. 1998;16(2):441-52.
• 25. Allred DC, Anderson SJ, Paik S, et al. Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol. 2012;30(12):1268-73.
• 26. Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2014;32(13):1365-83.
• 27. MacDonald HR, Silverstein MJ, Mabry H, et al. Local control in ductal carcinoma in situ treated by excision alone: incremental benefit of larger margins. Am J Surg. 2005;190(4):521-5.
• 28. Cutuli B, Fourquet A, Luporsi E, et al. Standards, options and recommendations for the management of ductal carcinoma in situ of the breast (DCIS): Update 2004. Bulletin du Cancer. 2005;92:155-68.
• 29. Dunne C, Burke J, Morrow M, et al. Effect of Margin Status on Local Recurrence After Breast Conservation and Radiation Therapy for Ductal Carcinoma In Situ. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2009;27:1615-20.
• 30. Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma In Situ. J Clin Oncol. 2016;34(33):4040-6.
• 31. Bijker N, Meijnen P, Peterse JL, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853--a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol. 2006;24(21):3381-7.
• 32. Cuzick J, Sestak I, Pinder S, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: Long-term results from the UK/ANZ DCIS trial. The lancet oncology. 2011;12:21-9.
• 33. Holmberg L, Garmo H, Granstrand B, et al. Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast. J Clin Oncol. 2008;26(8):1247-52.
• 34. Lagios MD, Silverstein MJ. Ductal carcinoma in situ. The success of breast conservation therapy: a shared experience of two single institutional nonrandomized prospective studies. Surg Oncol Clin N Am. 1997;6(2):385-92.
• 35. McCormick B, Winter K, Hudis C, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015;33(7):709-15.
• 36. Solin LJ, Gray R, Hughes LL, et al. Surgical Excision Without Radiation for Ductal Carcinoma in Situ of the Breast: 12-Year Results From the ECOG-ACRIN E5194 Study. J Clin Oncol. 2015;33(33):3938-44.
• 37. Allred DC, Anderson SJ, Paik S, et al. Adjuvant Tamoxifen Reduces Subsequent Breast Cancer in Women With Estrogen Receptor–Positive Ductal Carcinoma in Situ: A Study Based on NSABP Protocol B-24. Journal of Clinical Oncology. 2012;30(12):1268-73.
• 38. Margolese RG, Cecchini RS, Julian TB, et al. Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet. 2016;387(10021):849-56.