Treatment for Multi-focal DCIS

BCAE

Update: I was wondering if anyone who has had multifocal DCIS and a lumpectomy might share their experience. I am thinking about not doing whole breast radiation after lumpectomy to preserve my radiation option if a recurrence happens. I also read that invasive cancer tends to be unifocal anyway. And my Oncotype score is low for two of the biggest lesions (1cm, 2 cm, and 1mm). I am really stuck, not sure about what to do. Thanks!

I was wondering if anyone who has had a multi-focal DCIS was treated with Accelerated Partial Breast Irradiation (APBI). My RO says insurance probably won't cover it, and she wouldn't recommend it for me anyway...but I was trying to figure out why it's not used for such patients. I like APBI because it looks to have less side effects, and preserves options for the future. Can anyone point me to studies?

Also does anyone know how much more recurrence risk is associated with multi-focal DCIS in general? I have a low Oncotype DCIS score on one of my tumors (tested on my biopsy before lumpectomy confirmed multi-focal features), and am not sure how to put these together.

Thanks for your help!

MTwoman

BCAE, I had a similar diagnosis to yours, multi-focal DCIS; but my surgeon indicated that my only option was mx. Now, it's possible that is because 2 other areas of dcis weren't found until after my lx. I had an mri right before I was headed into rads which found 2 more areas of concern. They both turned out to be dcis and were in the opposite quadrant from my initial lump. My surgeon said that doing a second lx was not recommended as cosmetic outcome might be poor. This was 14 years ago, and some of the plastic techniques for filling in areas weren't being used frequently at that time. I think they were also concerned that there were more areas of dcis that were still 'in hiding' and wanted to make sure I had the most risk reduction possible, as I was 38. I didn't need rads after the mx, so can't really advise about the APBI. I would guess that your RO would know what it isn't recommended for you and "why it's not used for such patients". What did your RO say?

The attached study is "current controversies in radiotherapy for bc" and specifically discusses DCIS:

https://community.breastcancer.org/forum/83/topics/855477?page=1#idx_22

I'm sure others will chime in with more recent knowledge/experience.

Good luck!

BCAE

My RO pointed me to one study stating that multi-focal patients have a higher rate of recurrence (about 40%) without radiation. (Although the women in the study had high grade cancer, which I don't have have. Recently I also found an Oncotype presentation that seems to reference this study too.) http://ascopubs.org/doi/pdf/10.1200/jco.2007.11.46...

BUT then my MO said multifocality doesn't mean I have a higher risk. Confused what to do...APBI is off the table. Whole breast radiation is what my RO is recommending, but understands if I'd rather pass to preserve that option for a future recurrence (given my low Oncotype score).

Any other studies y'all think I should look at?

MTwoman

BCAE, it is confusing when different studies come to different conclusions. There are still many things for the medical community to understand about DCIS (what specific type of environmental factors does it take to push it into or inhibit it from becoming invasive). Any one study isn't typically used for decision making. When studies show interesting findings, then those findings need to be reproduced by another team, following the same protocols, and sometimes it takes additional studies to understand the mechanisms of action that explain why the finding occurs, before it's significance can be understood and trusted. That is why the NCCN standards are there, not to immediately include info from one study, but to bring together consensus guidelines from the totality of the studies to date. It is confusing and frustrating to get different opinions from 2 different members of your team. Can you ask for where they are getting this info? Reading it yourself might (or might not) be helpful. ((hugs))