Impact of resection margin width on local recurrence following breast-conserving surgery and whole breast radiotherapy for pure ductal carcinoma in situ: a systematic review and meta-analysis
Ara Darzi,
Hutan Ashrafian,
Ahmed Ezzat,
Josephine Holt,
Daniel R Leff,
Ronak Patel,
Michael Boland,
Ramsey I Cutress,
Hussein Elghazaly,
Meera Joshi,
Dhurka Shanthakumar,
Naomi Laskar,
Dimitri Hadjiminas,
Yasmin Grant,
Ravi Naik,
Nur Amalina Che Bakri,
Saur Hajev,
Alfie Roddan,
Susan Cleator
Affiliations
Ara Darzi
1 NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
Hutan Ashrafian
Department of Surgery and Cancer, Imperial College, London, UK
Ahmed Ezzat
Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
Josephine Holt
Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
Daniel R Leff
1 Department of Surgery and Cancer, Imperial College London, London, UK
Ronak Patel
Department of Rheumatology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
Michael Boland
National director of continuing education
Ramsey I Cutress
Cancer Sciences Academic Unit, University of Southampton, Southampton, UK
Hussein Elghazaly
1 Department of Surgery and Cancer, Imperial College London, London, UK
Meera Joshi
1 Department of Surgery and Cancer, Imperial College London, London, UK
Dhurka Shanthakumar
1 Department of Surgery and Cancer, Imperial College London, London, UK
Naomi Laskar
1 Department of Surgery and Cancer, Imperial College London, London, UK
Dimitri Hadjiminas
1 Department of Surgery and Cancer, Imperial College London, London, UK
Yasmin Grant
1 Department of Surgery and Cancer, Imperial College London, London, UK
Ravi Naik
1 Department of Surgery and Cancer, Imperial College London, London, UK
Nur Amalina Che Bakri
1 Department of Surgery and Cancer, Imperial College London, London, UK
Saur Hajev
1 Department of Surgery and Cancer, Imperial College London, London, UK
Alfie Roddan
1 Department of Surgery and Cancer, Imperial College London, London, UK
Susan Cleator
1 Department of Surgery and Cancer, Imperial College London, London, UK
Objective The aim of this study was to determine the impact of margin width and boost radiotherapy on the local recurrence risk of pure ductal carcinoma in situ (DCIS).Methods and analysis This is a prospectively registered systematic review and meta-analysis reporting relative risk (RR), OR and HR margin width outcomes. Eligible studies included prospective and retrospective case series with defining margin widths and 48 months of minimum follow-up. All patients (100%) received adjuvant whole breast radiotherapy (WBRT).Results A total of 40 265 patients with pure DCIS in 31 studies were included. ORs and RR were calculated from 15 studies in 12 519 patients, and HRs were calculated from 12 studies in 12 946 patients. Local recurrence was significantly greater with narrower ‘close’ margins; 0.1–1 mm versus >1 mm in RR (2.88, 95% CI 1.86 to 3.90; p<0.05), OR (4.82, 95% CI 2.45 to 9.48; p<0.05) and HR analysis (1.34, 95% CI 1.01 to 1.67; p<0.05). Compared with margins >2 mm, significantly greater local recurrence was observed in margins 0.1–2 mm in RR (1.72, 95% CI 1.09 to 2.35; p<0.05) and OR (4.43, 95% CI 3.02 to 6.50; p<0.05). Comparing 0.1–1 mm versus >1 mm and 0.1–2 mm versus >2 mm, differences in local recurrence were not statistically significant, once adjusted for boost radiotherapy.Conclusions In pure DCIS with WBRT, the local recurrence risk reduces as margin width increases up to 2 mm. The strength of the recommendation for a minimum clear margin of 2 mm is limited by a lack of data comparing 1.1–2 mm with >2 mm. The association between recurrence and close margins is not significant following boost radiotherapy, suggesting a possible alternative to re-excision in patients with close margins <2 mm.Systematic review registration CRD42022308524.
