Patients with ductal carcinoma in situ (DCIS) who have breast-conserving surgery that results in narrow, or “close,” negative surgical margins may not have to undergo repeat surgery if radiation therapy is performed, according to a recent analysis by researchers at The University of Texas MD Anderson Cancer Center.
The retrospective study—led by Audree Tadros, M.D., and Henry Kuerer, M.D., Ph.D., a fellow and a professor, respectively, in the Department of Breast Surgical Oncology—was performed to clarify the benefits of radiation therapy in preventing locoregional recurrence in DCIS patients after breast-conserving surgery with negative surgical margins less than 2 mm (i.e., with less than 2 mm of tumor-free tissue surrounding the tumor in the excised specimen). The optimal treatment strategy for such patients is not established. “Many multidisciplinary groups currently use the 2-mm margin as an absolute indication for repeat surgery,” Dr. Kuerer said.
Drs. Tadros and Kuerer and their colleagues looked at the records of nearly 1,500 DCIS patients who underwent breast-conserving surgery at MD Anderson between 1996 and 2010. Some patients had undergone postoperative radiation therapy, and some had not; none had undergone repeat surgery. The researchers compared the locoregional recurrence rates of patients with negative surgical margins greater than or equal to 2 mm and patients with negative margins less than 2 mm in the radiation and no-radiation groups.
Among patients who had undergone radiation therapy, the locoregional recurrence rates of those with negative surgical margins greater than or equal to 2 mm and those with margins less than 2 mm did not differ significantly. But among patients who had not undergone radiation therapy, the locoregional recurrence rate of those with surgical margins greater than or equal to 2 mm (5.4%) was significantly lower than that of patients with margins less than 2 mm (30.9%; P = .003).
“Patients with DCIS and margins less than 2 mm may not need repeat surgery if they receive radiation therapy,” Dr. Kuerer said. “Each case needs to be evaluated by a multidisciplinary team, taking into account the patient’s age, the extent of margin involvement, and the patient’s preferences.”
The study’s report was recently published online in the Annals of Surgery.
OncoLog, September 2017, Volume 62, Issue 9