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Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?

Identifying ductal carcinoma in situ (DCIS) patients at highest risk for recurrence after breast conserving surgery (BCS) remains a clinical concern. Subjecting all such patients to radiotherapy may be unnecessary. The Van Nuys Prognostic Index (VNPI) is a simple scoring system for predicting the ri...

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Autores principales: Kim, Taeryung, Park, Heung Kyu, Lee, Kyung Hee, Kim, Kwan Il, Lee, Kyu Chan, Ahn, Jeong Suk, Ko, Kwang-Pil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132440/
https://www.ncbi.nlm.nih.gov/pubmed/25133091
http://dx.doi.org/10.1186/2193-1801-3-405
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author Kim, Taeryung
Park, Heung Kyu
Lee, Kyung Hee
Kim, Kwan Il
Lee, Kyu Chan
Ahn, Jeong Suk
Ko, Kwang-Pil
author_facet Kim, Taeryung
Park, Heung Kyu
Lee, Kyung Hee
Kim, Kwan Il
Lee, Kyu Chan
Ahn, Jeong Suk
Ko, Kwang-Pil
author_sort Kim, Taeryung
collection PubMed
description Identifying ductal carcinoma in situ (DCIS) patients at highest risk for recurrence after breast conserving surgery (BCS) remains a clinical concern. Subjecting all such patients to radiotherapy may be unnecessary. The Van Nuys Prognostic Index (VNPI) is a simple scoring system for predicting the risk of local recurrence in patients with DCIS. We reviewed patients with DCIS applying the VNPI score system. A total of 184 DCIS patients who underwent surgery at our institution between January 2003 and December 2011 were identified. Patients were not treated according to VNPI guidelines; rather, radiation therapy was applied at each surgeon’s discretion. All patients with hormonal receptor positive tumors were treated with hormonal therapy. Pathology reports were reviewed and VNPI scores of each DCIS calculated. Of the 184 patients, 52 (28.3%), 115 (62.5%) and 17 (9.2%) had low, intermediate and high VNPI scores, respectively. Six of the 184 patients (3.3%) developed ipsilateral local recurrence, five in the intermediate and one in the high VNPI score group. Of the five in the intermediate group, three (60%) were in patients with ER-negative tumors. VNPI score itself was not associated with recurrence (P = 0.145). Factors associated with recurrence included tumor size (hazard ratio [HR] 6.88), grade (HR 9.07) and hormone receptor status (HR 11.75). Radiotherapy did not significantly improve recurrence rates in patients with low and intermediate risk DCIS, especially in those with ER-positive tumors. Radiotherapy can be omitted in patients with ER-positive intermediate score DCIS and in patients with low score DCIS.
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spelling pubmed-41324402014-08-15 Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery? Kim, Taeryung Park, Heung Kyu Lee, Kyung Hee Kim, Kwan Il Lee, Kyu Chan Ahn, Jeong Suk Ko, Kwang-Pil Springerplus Research Identifying ductal carcinoma in situ (DCIS) patients at highest risk for recurrence after breast conserving surgery (BCS) remains a clinical concern. Subjecting all such patients to radiotherapy may be unnecessary. The Van Nuys Prognostic Index (VNPI) is a simple scoring system for predicting the risk of local recurrence in patients with DCIS. We reviewed patients with DCIS applying the VNPI score system. A total of 184 DCIS patients who underwent surgery at our institution between January 2003 and December 2011 were identified. Patients were not treated according to VNPI guidelines; rather, radiation therapy was applied at each surgeon’s discretion. All patients with hormonal receptor positive tumors were treated with hormonal therapy. Pathology reports were reviewed and VNPI scores of each DCIS calculated. Of the 184 patients, 52 (28.3%), 115 (62.5%) and 17 (9.2%) had low, intermediate and high VNPI scores, respectively. Six of the 184 patients (3.3%) developed ipsilateral local recurrence, five in the intermediate and one in the high VNPI score group. Of the five in the intermediate group, three (60%) were in patients with ER-negative tumors. VNPI score itself was not associated with recurrence (P = 0.145). Factors associated with recurrence included tumor size (hazard ratio [HR] 6.88), grade (HR 9.07) and hormone receptor status (HR 11.75). Radiotherapy did not significantly improve recurrence rates in patients with low and intermediate risk DCIS, especially in those with ER-positive tumors. Radiotherapy can be omitted in patients with ER-positive intermediate score DCIS and in patients with low score DCIS. Springer International Publishing 2014-08-05 /pmc/articles/PMC4132440/ /pubmed/25133091 http://dx.doi.org/10.1186/2193-1801-3-405 Text en © Kim et al.; licensee Springer. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
spellingShingle Research
Kim, Taeryung
Park, Heung Kyu
Lee, Kyung Hee
Kim, Kwan Il
Lee, Kyu Chan
Ahn, Jeong Suk
Ko, Kwang-Pil
Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?
title Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?
title_full Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?
title_fullStr Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?
title_full_unstemmed Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?
title_short Is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?
title_sort is radiotherapy necessary for intermediate risk ductal carcinoma in situ after breast conserving surgery?
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132440/
https://www.ncbi.nlm.nih.gov/pubmed/25133091
http://dx.doi.org/10.1186/2193-1801-3-405
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