by Ju-Chun Chien, Wen-Shan Liu, Wei-Tzu Huang, Liang-Chung
Shih, Wen-Chung Liu, Yu-Chia Chen, Kang-Ju Chou, Yow-Ling Shiue, Pei-Chin Lin
The Breast: VOLUME 63, P29-36, JUNE
01, 2022
Purpose
Young age is associated with poor prognosis in ductal
carcinoma in situ (DCIS) of female breast and controversy exists regarding the
optimal treatment modality for young patients. We aimed to compare treatment
outcomes among breast conserving surgery (BCS), BCS with adjuvant radiotherapy
(BCS + RT), and total mastectomy (MT) for young DCIS women.
Methods
PubMed, Cochrane, and Embase were searched for studies
reporting comparative results among BCS, BCS + RT, or MT in ≤50 years
old (y/o) DCIS females. Study quality was assessed and meta-analysis with
subgroup analysis was performed to pool the effect sizes of the
outcomes-of-interest.
Results
We included 3 randomized control trials and 18 observational
studies. For DCIS women ≤50 y/o, RT following BCS significantly reduced
the risk for ipsilateral breast tumor recurrence (IBTR) (HR = 0.66,
95% CI 0.50–0.87). However, the benefit was less robust in extremely young
patients and with long follow-ups. RT revealed no statistically significant
preventive effect on ipsilateral invasive recurrence (HR = 1.38, 95%
CI 0.98–1.94). On the other hand, MT yielded the lowest IBTR
(BCS + RT vs MT: HR = 4.4, 95% CI 2.06–9.40), both in
ipsilateral DCIS recurrence and ipsilateral invasive recurrence. There was
great heterogeneity and could not reach an evident conclusion concerning
survival outcomes.
Conclusion
This study highlighted the varying effect of RT for young
DCIS females. The local control benefit of MT was definite without survival
differences observed. Our study provided a moderate certainty of evidence to
guide the treatment for young DCIS women. Further age-specific prospective
trial is warranted.
