Impact of young age on outcome in patients with ductal carcinoma-in-situ treated with breast-conserving therapy

Purpose: We reviewed our institution's experience treating patients with du ctal carcinoma-in-situ (DCIS) with breast-conserving therapy (BCT) to deter mine the impact of patient age on outcome. Patients and Methods: From 1980 to 1993, 146 patients were treated with BCT for DCIS, All patients underwent excisional biopsy, and 64% underwent reex cision, All patients received whole-breast irradiation to a median dose of 45 Gy, Ninety-four percent of patients received a boast to the tumor bed, f or a median total dose of 60.4 Gy, All slides an every patient were reviewe d by one pathologist, The median follow-up period was 7.2 years. Results: Seventeen patients developed an ipsilateral local recurrence, far 5- and 10-year actuarial rates of 10.2% and 12.4%, respectively, The 10-yea r rate of ipsilateral failure was 26.1% in patients younger than 45 years o f age versus 8.6% in older patients (P = .03). On multivariate analysis, yo ung age was independently associated with recurrence of the index lesion (t rue recurrence/marginal miss [TR/MM] failures), regardless of how it was an alysed (eg, < 45 years of age or as a continuous variable). In addition, yo ung patients had a dramatically higher 10-year rate of invasive TR/MM failu res (19.9% v 3.2%). In a separate multivariate analysis for the development of invasive TR/MM failures, only patient age cmd predominant nuclear grade were independently associated with recurrence, The relationship between ex cision volume and outcome was analysed in the 95 patients who underwent re- excision, The 5-year actuarial rate of TR/MM failure was significantly wors e only in young patients with smaller (< 40 mt) re-excision volumes (33.3% v 9.1%; P = .02). In a separate multivariate analysis of only these 95 pati ents (25 of whom were < 45 years of age), the volume of re-excision had the strongest association with outcome (P = .05). Patient age was no longer as sociated with local recurrence. Conclusion: These findings suggest that young patients with DCIS have a sig nificantly gt eater risk of local recurrence after BCT that is independent of other previously defined risk factors, Our data also suggest that the ex tent of resection may in part be related to the less optimal results that a re observed in these patients, (C) 2000 by American Society of Clinical Onc ology.