Radiation therapy for DCIS?


Question from Krys: I have had a diagnosis of DCIS. I have had a lumpectomy and the surgeon has suggested radiotherapy. I go to an acupuncturist and he has suggested I don't have radiotherapy. I like the idea of no radiotherapy. I would like some advice. I have been told that radiotherapy will damage some of my immune system which is the natural way to protect the body from cancer cells developing.
Answers - Beth Baughman DuPree, M.D., F.A.C.S. Depending upon the type of DCIS, the size of the area of DCIS, and the margin of normal tissue that was excised around the DCIS, the determination for whether or not to give radiation therapy is made by the surgeon, medical oncologist, and radiation oncologist. The standard treatment for DCIS would be to give radiation therapy to the entire breast with a boost to the tumor bed in order to prevent other cells that are like-minded from beginning to divide. The time to do so is at the diagnosis of a disease after adequate surgical resection. There are times with very low grade DCIS with wide margins, depending upon the age of the patient, where radiation therapy may not be recommended. But the standard of care would be to receive radiation therapy in the treatment of DCIS. I would certainly obtain an opinion from the radiation oncologist, the medical oncologist, and the surgeon. I respect the opinion of your acupuncturist, but the physicians who are trained to treat breast cancer may have information about your specific diagnosis that will help them to help you with a game plan for appropriate treatment.
Ruth Oratz, M.D., F.A.C.P. I agree 100 percent that the standard of practice is for radiation therapy following resection of DCIS except in very, very specific circumstances. And I would really emphasize the importance, as Dr. DuPree said, of having a conversation about this with the experts in the field with medical training.
Beth Baughman DuPree, M.D., F.A.C.S. Look at the DCIS in your breast as though you have a beautiful Victorian porch wrapped around your house. If you had termites in the steps of your porch, you would certainly have the steps removed. And prior to placing a new set of wooden steps onto your porch you would want to exterminate the porch and have a professional do this for you before rebuilding your steps.

Editor's Note: To help standardize the definition of negative margins, the American Society for Radiation Oncology and the Society of Surgical Oncology issued new guidelines in February 2014 saying that clear margins, no matter how small as long as there was no ink on the cancer tumor, should be the standard for lumpectomy surgery.

On Wednesday, September 20, 2006, our Ask-the-Expert Online Conference was called Open for Your Questions. Ruth Oratz, M.D., F.A.C.P. and moderator Beth Baughman DuPree, M.D., F.A.C.S. answered your questions covering a wide variety of issues relating to breast cancer.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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