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LUMPECTOMY PLUS RADIATION FOR INTRADUCTAL CARCINOMA-IN-SITU.

With the advent of mammography, the diagnosis of nonpalpable intraductal carcinoma-in-situ (DCIS) has increased. In a 1993 report, a randomized trial of 818 women with DCIS (most detected only by mammograms) showed that lumpectomy plus radiation reduced the five-year incidence of second ipsilateral tumors compared with lumpectomy alone (see JW June 15, 1993, or N Engl J Med 1993; 328:1581). This report provides additional follow-up.

At eight years, the cumulative incidence of second ipsilateral tumors remained significantly higher with lumpectomy alone than with lumpectomy plus radiation (27 vs. 12 percent). Half the tumors in the lumpectomy-only group were invasive, versus one third of those in the group receiving radiation and lumpectomy. Rates of contralateral tumors, distant metastases, and death remained low and similar in the two groups. The benefit from the addition of radiation was not confined to any identifiable subgroup.

Comment: Although lumpectomy plus radiation does not yet confer a survival advantage compared with lumpectomy alone for DCIS, these authors believe that the combined treatment should be offered to all women who are similar to the subjects in this study.

— AS Brett

Published in Journal Watch General Medicine February 24, 1998

Citation(s):

Fisher B et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: Findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 1998 Feb 16 441-452.

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