Surgery without Irradiation now an option for DCIS
A. Results reported at the annual conference of the National Comprehensive Cancer Network
B. The previous guidelines distinguished between the majority of women with ductal carcinoma in situ (DCIS) and the small subset of women with very small DCIS (<.5cm), unicentric, and of low grade.
C.The women with very small DCIS were treated with lumpectomy alone without irradiation. All other women with DCIS were treated with total mastectomy without lymph node disection or by lumpectomy plus irradiation.
1. The new guidelines make lumpectomy without irradiation an option for all women with DCIS.
2. The new options are;
a. Lumpectomy without lymph node surgery, plus whole breast radiation therapy.
b. Total mastectomy with or without sentinel node biopsy, and with or without breast reconstruction.
c. Lumpectomy alone, with no lymph node surgery and no radiation therapy.
3. The breast cancer guidelines committee now urges the use of radiation therapy for women who have 1-3 positive nodes.
4. Also new are recommendations on the use of breast reconstruction. The guidelines now warn that reconstruction, prior to radiation, has the potential to affect delivery of radiation therapy.
5. In one study, 52% of women who received radiation after reconstruction had some compromise in the application of radiation, either in terms of the field or the dosing to underlying structures.
6. Reconstruction before irradiation may lead to a worse cosmetic outcome.