Ductal carcinoma in situ of the breast results of conservative and radicaltreatments in 716 patients

Until now, less than 5% of the patients with breast ductal carcinoma in sit u (DCIS) have been enrolled in clinical trials. Consequently, we have analy sed the results of 'current practice' among 716 women treated in eight Fren ch Cancer Centres from 1985 to 1992: 441 cases (61.6%) corresponded to impa lpable lesions, 92 had a clinical size of less than or equal to 2 cm and 70 from 2 to 5 cm; in 113 cases, the size was unspecified. Median age was 53. 2 years (range: 21-87 years). 145 patients underwent mastectomy (RS) and 57 1 conservative surgery (CS) without (136) or with (435) radiotherapy (CS RT). The mean histological tumour sizes in these three groups were 25.6, 8. 2, 14.8 min, respectively (P <0.0001). After a 91-month median follow-up, l ocal recurrence (LR) rates were 2.1, 30.1 and 13.8% in the RS, CS and CS RT groups, respectively (P = 0.001); LR were invasive in 59 and 60% in the CS and CS + RT groups, respectively. In these groups, the 8-year LR rates w ere 31.3 and 13.9%, respectively (P = 0.0001). Nodal recurrence occurred in 3.7 and 1.8% in the CS and CS + RT groups. Metastases rates were 1.4, 4.4 and 1.4% in the RS, CS and CS + RT groups. Among the 60 cases of invasive L R, in CS and CS + RT groups 19% developed metastases. After multivariate an alysis, we did not identify any significant LR risk factor in the CS group, whereas young age (< 40years) and incomplete excision were significant in the CS + RT group (P = 0.012 and P = 0.02, respectively). (C) 2001 Elsevier Science Ltd. All rights reserved.