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Previous Volume 340:1455-1461 May 13, 1999 Number 19 Next

	Full Text PDF Editorial by Page, D. L. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Ductal carcinoma in situ is a noninvasive carcinoma that is unlikely to recur if completely excised. Margin width, the distance between the boundary of the lesion and the edge of the excised specimen, may be an important determinant of local recurrence.

Methods Margin widths, determined by direct measurement or ocular micrometry, and standardized evaluation of the tumor for nuclear grade, comedonecrosis, and size were performed on 469 specimens of ductal carcinoma in situ from patients who had been treated with breast-conserving surgery with or without postoperative radiation therapy, according to the choice of the patient or her physician. We analyzed the results in relation to margin width and whether the patient received postoperative radiation therapy.

Results The mean (±SE) estimated probability of recurrence at eight years was 0.04±0.02 among 133 patients whose excised lesions had margin widths of 10 mm or more in every direction. Among these patients there was no benefit from postoperative radiation therapy. There was also no statistically significant benefit from postoperative radiation therapy among patients with margin widths of 1 to <10 mm. In contrast, there was a statistically significant benefit from radiation among patients in whom margin widths were less than 1 mm.

Conclusions Postoperative radiation therapy did not lower the recurrence rate among patients with ductal carcinoma in situ that was excised with margins of 10 mm or more. Patients in whom the margin width is less than 1 mm can benefit from postoperative radiation therapy.

Source Information

From the Departments of Surgery (M.J.S.), Preventive Medicine (S.G.), and Medicine (J.R.W.), University of Southern California School of Medicine, and the Harold E. and Henrietta C. Lee Breast Center of the Kenneth Norris Jr. Comprehensive Cancer Center (M.J.S., S.G., J.R.W.) — both in Los Angeles; St. Mary's Hospital, San Francisco (M.D.L.); and the Breast Center, Van Nuys, Calif. (B.S.L., S.M., P.G., W.J.C.).

Address reprint requests to Dr. Silverstein at USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave., Rm. 7415, Los Angeles, CA 90033, or at msilverstein{at}surgery.usc.edu.

Full Text of this Article

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Vicini F. A., Kestin L. L., Goldstein N. S., Mokbel K., Wells C., Carpenter R., Harries S. A., Johnston A. O.B., Parker S. J., Heimann R., Karrison T., Hellman S., Silverstein M. J., Groshen S., Waisman J. R., Lagios M. D.
Extract | Full Text  
N Engl J Med 1999; 341:998-1000, Sep 23, 1999. Correspondence

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