Surgical, epidemiological and radiological aspects in the diagnosis and treatment of ductal carcinoma in situ of the breast.

Contains fulltext : 53013.pdf (Publisher’s version ) (Open Access)RU Radboud Universiteit Nijmegen, 12 december 2007Promotor : Wobbes, T. Co-promotores : Hennipman, A., Boetes, C.163 p

Should we undertake an MRI breast screening trial?

Contains fulltext : 52312.pdf (publisher's version ) (Closed access

Variations in treatment of ductal carcinoma in situ of the breast: a population-based study in the East Netherlands.

Contains fulltext : 53020.pdf (publisher's version ) (Closed access)AIMS: Differences in treatment of ductal carcinoma in situ (DCIS) of the breast were analysed for a geographically defined population in the East Netherlands. METHODS: Data from the Cancer Registry of the Comprehensive Cancer Centre East Netherlands were analysed for treatment of DCIS in the period between January 1989 and December 2003. The study population consisted of 800 female patients with a first diagnosis of DCIS of whom 798 underwent surgical treatment. The distribution of tumour characteristics and treatment were compared for several time periods. RESULTS: Surgical treatment was specified for 648 patients: 51% underwent breast-conserving surgery. The proportion of patients treated with breast-conserving surgery increased: 43% in the period 1994-1998 and 55 after 1999 (p<0.01). An axillary staging procedure was performed in 149 patients (19%), of whom 2 (1%) had tumour-involved lymph nodes. Of patients treated with breast-conserving surgery, 133 (40%) received radiation therapy: 7% in the period 1994-1998 compared to 62% after 1999 (p<0.01). Patients (60%) of 50 years or younger were treated with mastectomy compared to 44% in patients aged 50-69 years and 50% in patients of 70 years and older (p<0.01). The rate in use of radiation therapy after breast-conserving surgery was comparable to both age groups. CONCLUSION: This study shows variability in the treatment of DCIS in a geographically defined region. Approximately half of all patients were treated with mastectomy and 19% underwent an axillary staging procedure; this may represent aggressive, unwarranted treatment. In contrast, 38% of patients treated with breast-conserving surgery were not treated with radiation therapy after 1999, which may represent under-treatment

Het ductaal carcinoom in situ van de borst. Chirurgische aspecten en de plaats van de MRI.

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A cardiogastric fistula after gastric tube interposition. A case report and review of literature.

A patient is presented with massive hematemesis caused by a fistula between the left cardiac atrium and a gastric tube interposition, which was constructed after esophagectomy for esophageal cancer 3 years earlier

Local Recurrences After Conservative Treatment of Ductal Carcinoma-In-Situ of the Breast Without Radiotherapy: The Effect of Age

Background: The main goal in treatment of ductal carcinoma-in-situ (DCIS) of the breast is to prevent local recurrences. Radiotherapy after breast-conserving surgery has been shown to decrease the recurrence rate, although whether all patients should be treated with radiotherapy remains a topic of debate. The aim of this study was to assess the local recurrence rate after conservative surgical treatment of DCIS without radiotherapy and to identify risk factors for local recurrence. Methods: A total of 499 female patients with 502 DCIS lesions treated in the period 1989 to 2002 were retrospectively reviewed. Survival rates were calculated by the Kaplan-Meier method, and differences were tested by using the log-rank test. The association of variables with local recurrence was analyzed by using the v2 test. Results: Treatment constituted of lumpectomy in 329 patients (65%). Thirty-eight patients (8%) had disease-positive margins, and for 41 patients (8%) the margin status was not known. Eighty tumors recurred, for a local recurrence rate of 13% after 4 years compared with 17% for patients treated with breast-conserving surgery only. Risk factors for ipsilateral recurrences were younger age (<50 years), treatment with breast-conserving surgery only, and presence of disease-involved surgical margins. Conclusions: Conservative treatment of DCIS results in high recurrences rates, and outcomes can be improved by performing more radical surgery. Because radiotherapy has been shown to be effective in preventing recurrent disease, and, to date, no subgroups have been identified in which radiation can be omitted, its use is recommended, especially in younger patients