J Cancer 2017; 8(14):2653-2662. doi:10.7150/jca.20871

Review

DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes

Henry M. Kuerer1✉, Benjamin D. Smith2, Mariana Chavez-MacGregor3, 4, Constance Albarracin5, Carlos H. Barcenas3, Lumarie Santiago6, Mary E. Edgerton5, Gaiane M. Rauch6, Sharon H. Giordano3, 4, Aysegul Sahin5, Savitri Krishnamurthy3, Wendy Woodward2, Debasish Tripathy3, Wei T. Yang6, Kelly K. Hunt1✉

1. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX;
2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX;
3. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX;
4. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX;
5. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX;
6. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.

Abstract

Recent published guidelines suggest that adequate margins for DCIS should be ≥ 2 mm after breast conserving surgery followed by radiotherapy (RT). Many groups now use this guideline as an absolute indication for additional surgery. This article describes detailed multidisciplinary practices including extensive preoperative/intraoperative pathologic/histologic image-guided assessment of margins, offering some patients with small low/intermediate grade DCIS no RT, the use/magnitude of radiation boost tailoring to margin width, and endocrine therapy for ER-positive DCIS. Use of these protocols over the past 20-years has resulted in 10-year local recurrence rates below 5% for patients with negative margins < 2 mm who received RT. Patients with margins < 2 mm who do not receive RT experience significantly higher local failure rates. Thus, there is not an absolute need to achieve wider negative surgical margins when < 2 mm for patients treated with RT and this should be determined by the multidisciplinary team. Utilization of these multidisciplinary treatment protocols and techniques may not be exportable and extrapolated to all hospitals, breast programs and systems as they can be complex and resource intensive.

Keywords: DCIS, ductal carcinoma in situ, breast cancer, surgery, pathology, radiotherapy, margins.

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How to cite this article:
Kuerer HM, Smith BD, Chavez-MacGregor M, Albarracin C, Barcenas CH, Santiago L, Edgerton ME, Rauch GM, Giordano SH, Sahin A, Krishnamurthy S, Woodward W, Tripathy D, Yang WT, Hunt KK. DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes. J Cancer 2017; 8(14):2653-2662. doi:10.7150/jca.20871. Available from http://www.jcancer.org/v08p2653.htm