Therapeutic strategy for ductal carcinoma in situ patients according to Van Nuys Prognostic Index

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COD: 10_2167_254-259 Categorie: ,

Michela Andretta, Serena Scomersi, Monica Urbani, Marina Bortul

Ann. Ital. Chir., 2014 85: 254-259

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AIM: Evaluation of therapeutic strategy for Ductal Carcinoma In Situ (DCIS) patients at our Brest Cancer Centre and
analysis of our pattern of treatment with respect to Van Nuys Prognostic Index (VNPI) cathegories.
MATHERIAL OF STUDY: Our study population is the result of a selection of 85 DCIS patients classified according to the
VNPI risk of Local Recurrence (LR). A comparison was made between treatment effectively performed and therapy suggested
by VNPI protocols.
RESULTS: Out of 53 DCIS women (62%) at low local recurrence risk, 5 patients underwent Breast Conserving Surgery
(BCS) alone, 7 were treated with mastectomy and 41 underwent BCS followed by radiotherapy (RT). Out of 31 patients
(37%) belonging to VNPI intermediate risk group, 25 cases recived BCS+RT and 6 cases received mastectomy. Only
one patient (1%) belonged to VNPI high risk group and underwent mastectomy.
DISCUSSION: Only 31 patients (36,5%) had their definitive treatment according to recommended VNPI criteria, but
none of the other 54 cases (63,5%) was undertreated. Performing mastectomy instead of BCS or adding adjuvant
radiotherapy at BCS alone were not considered overtreatment because the therapeutic strategy was the result of a
multidisciplinary discussion.
CONCLUSION: As DCIS is a heterogeneus desease the one-size-fits-all approach to treatment seems inappropriate. The
VNPI was developed in order to help treatment choices, but therapeutic strategies can’t be based only on local recurrence
risk and need a multidisciplinary approach.

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