Originally published as JCO Early Release 10.1200/JCO.2008.17.5182 on March 2 2009

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dunne, C. Articles by Kell, M. R. Search for Related Content PubMed PubMed Citation Articles by Dunne, C. Articles by Kell, M. R. Social Bookmarking                            What's this?

Effect of Margin Status on Local Recurrence After Breast Conservation and Radiation Therapy for Ductal Carcinoma In Situ

From the Eccles Breast Screening Unit, Mater Misericordiae University Hospital, Dublin, Ireland; and Department of Surgical Oncology, Memorial Sloan-Kettering Cancer Centre, New York, NY.

Corresponding author: Malcolm R. Kell, MD, FRCSI, FRCS (Glasg), Eccles Breast Screening Unit, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland; e-mail: malcolm.kell{at}breastcheck.ie.

Purpose There is no consensus on what constitutes an adequate surgical margin in patients receiving breast-conserving surgery (BCS) and postoperative radiation therapy (RT) for ductal carcinoma in situ (DCIS). Inadequate margins may result in high local recurrence, and excessively large resections may lead to poor cosmetic outcome without oncologic benefit.

Methods A comprehensive search for published trials that examined outcomes after adjuvant RT after BCS for DCIS was performed using MEDLINE and cross referencing available data. Reviews of each study were conducted, and data were extracted. Primary outcome was ipsilateral breast tumor recurrence (IBTR) related to surgical margins.

Results A total of 4,660 patients were identified from trials examining BCS and RT for DCIS. Patients with negative margins were significantly less likely to experience recurrence than patients with positive margins after RT (odds ratio [OR] = 0.36; 95% CI, 0.27 to 0.47). A negative margin significantly reduced the risk of IBTR when compared with a close (OR = 0.59; 95% CI, 0.42 to 0.83) or unknown margin (OR = 0.56; 95% CI, 0.36 to 0.87). When specific margin thresholds were examined, a 2-mm margin was superior to a margin less than 2 mm (OR = 0.53; 95% CI, 0.26 to 0.96); however, we saw no significant difference in the rate of IBTR with margins between 2 mm and more than 5 mm (OR = 1.51; 95% CI, 0.51 to 5.0; P > .05).

Conclusion Surgical margins negative for DCIS should be obtained after BCS for DCIS. A margin threshold of 2 mm seems to be as good as a larger margin when BCS for DCIS is combined with RT.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. Goldhirsch, J. N. Ingle, R. D. Gelber, A. S. Coates, B. Thurlimann, H.-J. Senn, and Panel members Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2009 Ann. Onc., August 1, 2009; 20(8): 1319 - 1329. [Abstract] [Full Text] [PDF]