Ductal carcinoma in situ: Management of breast relapses after initial treatment

The principles and results of treatment for breast relapses after breast conservation therapy or mastectomy for ductal carcinoma in situ (DCIS) are reviewed, and institutional results following a breast relapse after conservation therapy are reported. A total of 177 histologically-confirmed ductal in-situ tumors of the breast in 174 patients were treated with wide local tumor excision or quadrantectomy and breast irradiation (48 to 50 Gy in 1.8 to 2 Gy daily dose). Boost to the primary tumor excision site was delivered with 9 MeV or 12-MeV electrons (10 to 20 Gy). Minimum follow-up was 3 years (median, 7 years; maximum, 15 years). The overall local tumor recurrence rate was 9% (17 of 177), and the actuarial relapse rate at 10 years was 12%. Distant metastases developed in 3 patients who also had metachronous invasive ductal carcinoma in the contralateral breast. The l0-year actuarial disease-free survival rate was 98%. Breast relapses after breast carcinoma conservation therapy are usually treated with total or modified radical mastectomy, which depends on the histology of the recurrent tumor. Most recurrences after mastectomy are treated with irradiation and excision of the gross tumor, when technically feasible. The prognosis for survival after treatment of DCIS relapses is excellent.