Intraductal carcinoma of the breast: results of treatment with excisional biopsy and irradiation.

Abstract

Between 1976 and 1983, 40 women with intraductal carcinoma of the breast without invasion underwent excisional biopsy and irradiation as an alternative to mastectomy. The median age was 53 years (range, 28 to 77 years) and the median follow-up time since initiation of radiation was 44 months (range, 14 to 97 months). Twenty-seven patients presented with a palpable mass: in 13 patients the tumor was only detected by mammography. A limited axillary dissection was performed in 13 patients, and all lymph nodes removed were negative. Treatment was administered to the breast and adjacent chest wall to a dose of 4,600 to 5,000 rad, with 26 patients also receiving a boost dose of 1000 to 2000 rad to the site of the primary. Four patients have developed a recurrence in the treated breast, at 17, 19, 35, and 63 months after the beginning of radiation therapy. The 5-year actuarial rate of local recurrence is 10%. Three of the recurrences were in those 4 patients who presented with a nipple discharge and a central primary. In 2 cases, the recurrence consisted of only intraductal carcinoma; in the other 2, both intraductal and invasive cancer were found. All 4 patients with recurrence underwent mastectomy and are well without evidence of distant metastases at 0, 12, 15, and 15 months since mastectomy. Cosmetic results were excellent. No patient has developed distant metastases. Since the number of patients treated is small and the period of follow-up is short, one must be cautious in the interpretation of these results. Nonetheless, the treatment of intraductal carcinoma of the breast by excision an irradiation appears to give acceptable local control and excellent survival when suitable precautions of patient selection and evaluation are taken.