SALVAGE TREATMENT FOR LOCAL RECURRENCE FOLLOWING BREAST-CONSERVING SURGERY AND DEFINITIVE IRRADIATION FOR DUCTAL CARCINOMA IN-SITU (INTRADUCTAL CARCINOMA) OF THE BREAST

Purpose: The purpose of the present study is to evaluate the outcome o f salvage treatment for local recurrence in the breast following the i nitial treatment of ductal carcinoma in situ (intraductal carcinoma) w ith breast-conserving surgery and definitive breast irradiation. Metho ds and Materials: An analysis was performed of 42 local failures in th e breast that occurred following the initial treatment of ductal carci noma in situ (intraductal carcinoma) with breast-conserving surgery an d definitive breast irradiation. At the time of the local recurrence, 23 cases (55%) showed invasive ductal carcinoma, and 19 cases (45%) sh owed intraductal carcinoma, one with associated Paget's disease. The s urgical treatment at the time of local recurrence included mastectomy (n = 39), excision (n = 2), or other (n = 1). Adjuvant systemic therap y at the time of local recurrence included chemotherapy (n = 2), hormo nal treatment (n = 7), both (n = 1), or none (n = 32). The median foll ow-up after salvage treatment was 3.7 years (mean = 4.0 years; range = 0.1-9.5 years). Results: The 5-year actuarial outcome following salva ge treatment for the 42 local recurrences showed an overall survival r ate of 78% and a cause-specific survival rate of 84%. The 5-year actua rial rate of freedom from distant metastases was 86%. None of the pati ents with histology of the local recurrence of intraductaI carcinoma o r with detection of the local recurrence with mammographic findings on ly developed distant metastatic disease after salvage treatment. The 5 -year actuarial rate of freedom from chest wall recurrence following s alvage mastectomy was 92%. All three of the patients who developed che st wall recurrence following salvage mastectomy also developed distant metastatic disease. Conclusions: These results demonstrate that local recurrences following the initial treatment of ductal carcinoma in si tu with breast-conserving surgery and definitive breast irradiation ca n be salvaged with high rates of survival, freedom from distant metast ases, and freedom from chest wall recurrence. The results of salvage t reatment support the use of breast-conserving surgery and definitive b reast irradiation for the initial management of ductal carcinoma in si tu of the breast.