ANALYSIS OF THE FACTORS DETERMINING THE EFFICIENCY OF TREATMENT IN PATIENTS WITH NON-INVASIVE INTRADUCTAL BREAST CANCER

Fedosov A.E.¹, Zhygulin A.V.¹, Cheshuk V.Y.²

• ¹Hospital of Israeli Oncology LISOD
• ²Bogomolets National Medical University, Kyiv, Ukraine

Currently, clinicians’ opinions regarding the optimal scope of surgical and adjuvant treatment of patients with breast non-invasive intraductal cancer (DCIS) are ambiguous. Since the presence of DCIS increases the risk of invasive malignant neoplasm develo­ping by 2–8 times, clarification of this issue is indispensable. Aim: to analyze the long-term treatment results of patients with DCIS of the mammary gland, depending on the clinical and pathological characteristics, receptor status, tumor grade, type and characteristics of surgical and adjuvant treatment. Object and methods: the clinical records of 79 patients (aged 22–60 years) with DCIS of the breast were analyzed. In accordance with current standards for the breast carcinoma diagnosis, all the patients underwent a complete mammological instrumental examination; the diagnosis was confirmed by histopathological examination; the resection margin was assessed intraoperatively; tumor tissues were examined postoperatively. All the patients underwent surgical treatment (organ-preserving or mastectomy with one-stage reconstruction); 38.0% of patients received postoperative radiation therapy (SOD 40–50 Gy); patients with tumors expressing steroid hormone receptors were given hormone therapy with tamoxifen. The median follow-up period was 91.8 months. Results: in the majo­rity cases, the patients were 40–50 years old (63.3%), the tumor nodes measured 1.0–7.0 cm (68.4%), receptor status was ER⁺PR^+/–HER2/neu^– (86.1%) and differentiation grade was G3 (58.3%). In 6.3%, DCIS was associated with Paget’s disease. During a follow-up period of 36–152 months, local relapses were found in 8.9% (seven cases); one patient died. The local recurrence development was associated with the patients’ young age (<30 years), multicentric tumor, it’s triple negative molecular type, and the lack of adjuvant treatment. Conclusions: the necessity to evaluate and exclude DCIS spread to the nipple is demonstrated. In high-risk cases, patients with DCIS of the mammary gland should have surgical excision with clean resection margins (R0), if necessary, mastectomy, with adjuvant radiation and (if indicated) hormone therapy.