Lobular carcinoma in situ (LCIS) of the breast: is long-term outcome similar to ductal carcinoma in situ (DCIS)? Analysis of 200 cases

Radiation Oncology

Catherine Delva²  Claire Brunaud⁸  Sandrine Avigdor⁷  Agnes Tallet⁵  Hugues Auvray⁴  Youlia Kirova¹  Brigitte De Lafontan⁶  Bruno Cutuli³ 

[1] Institut Curie, Paris, France;Sylia-Stat, Bourg-la-Reine, France;Institut du Cancer Courlancy, Reims, France;Centre Henri Becquerel, Rouen, France;Institut Paoli-Calmettes, Marseille, France;Institut Claudius Regaud, Toulouse, France;Centre Hospitalier Régional, Orleans, France;Institut de Cancerologie de Lorraine, Vandoeuvre-les-Nancy, France

关键词: Breast-conserving surgery;    Radiotherapy;    Local recurrence;    Treatment;    Breast cancer;    Lobular carcinoma in situ;   

Others  :  1226192
DOI  :  10.1186/s13014-015-0379-7

 received in 2015-01-04, accepted in 2015-03-16,  发布年份 2015

【 摘 要 】

Background

Lobular carcinomas in situ (LCIS) represent 1-2% of all breast cancers. Both significance and treatment remain widely debated, as well as the possible similarities with DCIS.

Materials and methods

Two hundred patients with pure LCIS were retrospectively analyzed in seven centres from 1990 to 2008. Median age was 52 years; 176 patients underwent breast-conserving surgery (BCS) and 24 mastectomy. Seventeen patients received whole breast irradiation (WBRT) after BCS and 20 hormonal treatment (15 by tamoxifen).

Results

With a 144-month median follow-up (FU), there were no local recurrences (LR) among 24 patients treated by mastectomy. With the same FU, 3 late LR out of 17 (17%) occurred in patients treated by BCS and WBRT (with no LR at 10 years). Among 159 patients treated by BCS alone, 20 developed LR (13%), but with only a 72-month FU (17.5% at 10 years). No specific LR risk factors were identified. Three patients developed metastases, two after invasive LR; 22 patients (11%) developed contralateral BC (59% invasive) and another five had second cancer.

Conclusions

LCIS is not always an indolent disease. The long-term outcome is quite similar to most ductal carcinomas in situ (DCIS). The main problems are the accuracy of pathological definition and a clear identification of more aggressive subtypes, in order to avoid further invasive LR. BCS + WBRT should be discussed in some selected cases, and the long-term results seem comparable to DCIS.

【 授权许可】

   
2015 Cutuli et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Venkitaraman R. Lobular neoplasia of the breast. Breast J. 2010; 5:519-28.
• [2]Hussain M, Cunnick GH. Management of lobular carcinoma in situ and atypical lobular hyperplasia of the breast: a review. Eur J Surg Oncol. 2011; 37:279-89.
• [3]King TA, Reis-Filho JS. Lobular Neoplasia. Surg Oncol Clin N Am. 2014; 23:487-503.
• [4]Boyages J, Delaney G, Taylor R. Predictors of local recurrence after treatment of Ductal Carcinoma In Situ. A meta-analysis Cancer. 1999; 85:616-28.
• [5]Cutuli B, Bernier J, Poortmans P. Radiotherapy in DCIS, an underestimated benefit? Radiother Oncol. 2014; 112:1-8.
• [6]Li C, Malone KE, Saltzman BS, Daling FR. Risk of invasive carcinoma among women diagnosed with ductal carcinoma in situ and lobular carcinoma in situ 1988–2001. Cancer. 2006; 106:2104-12.
• [7]Marmor S, Portschy PR, Nzara R, Tuttle TM, Virnig BA. Trends in incidence and management of lobular carcinoma in situ: a population-based analysis. Ann Surg Oncol. 2013; 20:3240-6.
• [8]Levi F, Te VC, Randimbison L, La Vecchia C. Trends of in situ carcinoma of the breast in Vaud, Switzerland. Eur J Cancer. 1997; 33:903-6.
• [9]Oliveira TM, Elias JRJ, Melo AF, Teixeira SR, Filho SC, Goncalves LM et al.. Evolving concepts in breast lobular neoplasia and invasive lobular carcinoma, and their impact on imaging methods. Insight Imaging. 2014; 5:183-94.
• [10]Rendi MH, Dintzis SM, Lehman CD, Calhoun KE, Allison KH. Lobular in-situ neoplasia on breast care needle. Biopsy: imaging indications and pathologic extent can identify which patients require excisional biopsy. Ann Surg Oncol. 2012; 19:914-21.
• [11]Anderson BO, Calhoun KE, Rosen EL. Evolving concepts in the management of lobular neoplasia. J Natl Compr Cancer Netw. 2006; 4:511-22.
• [12]Bratthauer GL, Tavassoli FA. Lobular intraepithelial neoplasia: previously unexplored aspects assessed in 775 cases and their clinical implications. Vinchows Arch. 2002; 440:134-8.
• [13]Lakhani SR, Audretsch W, Cleton-Jensen AM, Cutuli B, Ellis I, Eusebi V et al.. The management of lobular carcinoma in situ (LCIS). Is LCIS the same as ductal carcinoma in situ (DCIS)? Eur J Cancer. 2006; 42:2205-11.
• [14]Lewis JL, Lee DY, Tartter PI. The significance of lobular carcinoma in situ and atypical hyperplasia of the breast. Ann Surg Oncol. 2012; 19:4124-8.
• [15]Murray MP, Luedtke C, Liberman L, Nehhozina T, Akram M, Brogi E. Classic lobular carcinoma in situ and atypical lobular hyperplasia at percutaneous breast care biopsy. Outcomes of prospective excision. Cancer. 2013; 119:1073-9.
• [16]Zhao C, Desouki MM, Florea A, Mohammed K, Li X, Dabbs D. Pathologic findings of follow-up surgical excision for lobular neoplasia on breast care biopsy performed for calcification. Am J Clin Pathol. 2012; 138:72-8.
• [17]Bleicher RJ. Ductal carcinoma in situ. Surg Clin N Am. 2013; 93:393-410.
• [18]Mokbel K, Cutuli B. Heterogeneity of ductal carcinoma in situ and its effects on management. Lancet Oncol. 2006; 7:756-65.
• [19]Schouten Van Der Velden AP, Van Vugt R, Van Duck JA, Leer JW, Wobbes T. Local recurrences after different treatement strategies for ductal carcinoma in situ of the breast: a population-based study in the east Netherlands. Int J Radiat Oncol Biol Phys. 2007; 69:703-10.
• [20]Tunon De Lara C, Andre G, Mac Grogan G, Dilhuydy JM, Bussieres JE, Debled M et al.. Ductal carcinoma in situ of the Breast: influence of age on diagnostic, therapeutic and prognostic features. Retrospective study of 812 patients. Ann Surg Oncol. 2011; 18:1372-9.
• [21]Wapnir IL, Dignam JJ, Fisher B, Mamounas EP, Anderson SJ, Julian TB et al.. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011; 103:478-88.
• [22]Donker M, Litiere S, Werutski G, Julien JP, Fentiman IS, Agresti R et al.. Breast-conserving treatment with or without radiotherapy in ductal carcinoma in situ: 15-year recurrence rates and outcomes after a recurrence rates and outcome after a recurrence, from EORTC 10583 randomized phase III trial. J Clin Oncol. 2013; 31:4054-9.
• [23]Holmberg L, Garmo H, Grandstrand B, Ringberg A, Arnesson LG, Sandelin K et al.. Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for Ductal Carcinoma in situ of the Breast. J Clin Oncol. 2008; 26:1247-52.
• [24]Cuzick J, Sestak I, Pinder SE, Ellis IO, Forsyth S, Bundered NJ et al.. Effect of Tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results of from the UK/ANZ DCIS trial. Lancet Oncol. 2011; 12:21-9.
• [25]Correa C, MC Gale P, Taulor C, Wang Y, Clarke M et al.. Overview of the randomized trial of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monog. 2010; 41:162-77.
• [26]Alvarado R, Lari SA, Roses RE, Smith BD, Yang W, Mittendorf EA et al.. Biology treatment and outcome in very young and older women with DCIS. Ann Surg Oncol. 2012; 19:3777-84.
• [27]Halasz LM, Sreedhara M, Chen YH, Bellon JR, Punglia RS, Wong J et al.. Improved outcomes of breast-conserving therapy for patients with ductal carcinoma in situ. Int J Rad Oncol Biol Phys. 2012; 82:e581-6.
• [28]Falk RS, Hofvind S, Skaane P, Haldorsen T. Second events following ductal carcinoma in situ of the breast: a register-based cohort study. Breast Cancer Res Treat. 2011; 129:929-38.
• [29]Mccormick B, Winter C, Hudis C, Kuerer HM, Rakovitch E, Smith BL et al.. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015; 33:709-15.
• [30]Kerlikowske K, Molinaro AM, Gauthier ML, Berman HK, Waldman F, Bennington F et al.. Biomarker expression and risk of subsequent tumors after initial ductal carcinoma in situ diagnosis. J Natl Cancer Inst. 2010; 102:627-37.
• [31]Rakovitch E, Narod SA, Nofech-Moses S, Hanna W, Thiruchelvam D, Saskin R et al.. Impact of boost radiation in the treatment of ductal carcinoma in situ: a population-based analysis. Int J Rad Oncol Biol Phys. 2013; 86:491-7.
• [32]Cutuli B, Lemanski C, Le Blanc-Onfroy M, De Lafontan B, Cohen-Solal-Lenir C, Fondrinier E et al.. Local recurrence after ductal carcinoma in situ breast conserving treatment. Analysis of 195 cases. Cancer-Radiotherapie. 2013; 17:196-201.
• [33]Salvadori B, Bartoli C, Zurrida S, Delledonne V, Squicciarini P, Rovini D et al.. Risk of invasive cancer in women with lobular carcinoma in situ of the breast. Eur J Cancer. 1991; 27:35-7.
• [34]Ottesen GL, Graversen HP, Blichert-Toft M, Zedeler K, Andersen JA. Lobular carcinoma in situ of the female breast. Short-term results of a prospective nationwide study. The Danish Breast Cancer Cooperative Group. Am J Surg Pathol. 1993; 17:14-21.
• [35]Fisher ER, Land SR, Fisher B, Mamounas E, Gilarski L, Wolmark N. Pathologic findings from the National Surgical Adjuvant Breast and Bowel Project twelve-year observations concerning lobular carcinoma in situ. Cancer. 2004; 100:234-44.
• [36]Chuba PJ, Hamre MR, YAP J, Severson RK, Lucas D, Shamsa F et al.. Bilateral risk for subsequent breast cancer after lobular carcinoma in situ: analysis of surveillance. Epidemiology and End Results data. J Clin Oncol. 2005; 23:5534-41.
• [37]Hughes LL, Wang M, Page DL, Gray R, Solin LJ, Davidson NE et al.. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009; 27:5319-24.
• [38]Cutuli B, DE Lafontan B, Quetin P, Mery E. Breast conserving surgery and radiotherapy a possible treatment for lobular carcinoma in situ ? Eur J Cancer. 2005; 41:380-5.
• [39]Vincent-Salmon A, Hajage D, Rouquette A, Cedenot A, Gruel N, Alran S et al.. High Ki67 expression is a risk marker of invasive relapse for classical lobular carcinoma in situ patients. Breast. 2012; 21:380-3.
• [40]Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah H, Cronin WM et al.. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998; 90:1371-88.
• [41]Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN et al.. Effects of tamoxifen vs raloxifen on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of tamoxifen and raloxifen (STAR) P-2 trial. JAMA. 2006; 295:2727-41.
• [42]Claus E, Stowe M, Carter D, Holford T. The risk of contralateral breast cancer among women diagnosed with ductal and lobular breast carcinoma in situ: data from Connecticut Tumor Registry. Breast. 2003; 12:451-6.
• [43]Recht A. Should patients with lobular carcinoma in situ be irradiated? Not yet, but. Eur J Cancer. 2005; 41:344-5.