Conservative management of XXXX with radiotherapy: 10- and 15-year results.

@entity1 @entity5 @entity1558 @entity513
BACKGROUND: At 5-year follow-up, @entity1 with @entity1558 who were treated with breast-conserving surgery (BCS) and radiotherapy (RT) had excellent results. The current report provides 10- and 15-year rates of @entity5 control in the breast, as well as disease-free and overall survival rates following BCS and RT in a cohort of @entity1 with Paget disease presenting without a palpable mass or mammographic density. METHODS: Through a collaborative review of @entity1 treated with BCS and RT from seven institutions, 38 cases of @entity1558 presenting without a palpable mass or mammographic density were identified. All @entity1 had pathologic confirmation of typical Paget cells at time of diagnosis. Thirty-six of 38 @entity1 had a minimum follow-up greater than 12 months and constitute the study cohort. Ninety-four percent of @entity1 underwent complete or partial excision of the nipple-areola complex and all @entity1 received a median external beam irradiation dose of 50 Gy (range, 45-54 Gy) to the whole breast. Ninety-seven percent of @entity1 also received a boost to the remaining nipple or @entity5 bed, a median total dose of 61.5 Gy (range, 50.4-70 Gy). RESULTS: With median follow-up of 113 months (range, 18-257 months), 4 of 36 @entity1 (11%) developed a first recurrence of disease in the treated breast only. Two of the four recurrences in the breast were @entity513 in situ (DCIS) only and two were invasive with DCIS. Two additional @entity1 had a recurrence in the breast as a component of first failure. Actuarial local control rates for the breast as the only site of first recurrence were 91% at 5 years (95% confidence interval [CI], 80-100%) and 87% (95% CI, 75-99%) at both 10 and 15 years. Actuarial local control rates for breast recurrence, as a component of first failure, were 91% (95% CI, 80-100%), 83% (95% CI, 69-97%), and 76% (95% CI, 58-94%) at 5, 10, and 15 years, respectively. No clinical factors were identified as significant predictors for breast recurrence. Five-, 10- and 15-year actuarial rates for survival without disease of 97% (95% CI, 90-100%) and 5-, 10-, and 15-year actuarial rates of overall survival of 93% (95% CI, 84-100%) at 5 years and 90% (95% CI, 78-100%) at 10 and 15 years were reported. CONCLUSIONS: These data confirm excellent rates of local control, disease-free survival, and overall survival at 10 and 15 years following BCS and RT for @entity1558 . This study continues to support the recommendation of local excision and definitive breast irradiation as an alternative to mastectomy in the treatment of @entity1 with Paget disease presenting without a palpable mass or mammographic density.
