Breast-Conserving Treatment With or Without Radiotherapy in Ductal Carcinoma In Situ: 15-Year Recurrence Rates and Outcome After a Recurrence, From the EORTC 10853 Randomized Phase III Trial

Donker, Mila; Litière, Saskia; Werutsky, Gustavo; Julien, J.P.; Fentiman, Ian S.; Agresti, Roberto; Rouanet, Philippe; Lara, C. Tunon de; Bartelink, Harry; Duez, Nicole; Rutgers, Emiel J.; Bijker, Nina

doi:10.1200/jco.2013.49.5077

Cited by 322 publications

(289 citation statements)

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“…5 Approximately half of the recurrences will be invasive carcinoma, requiring more extensive treatment, and with a possible decrease in disease-specific survival. 6 Radiotherapy reduces the recurrence rate by about 50%, so despite the fact that only small a small proportion of patients will benefit, many clinicians recommend radiotherapy because of the implications of invasive recurrence. The most commonly used predictive models to estimate the recurrence risk with or without radiotherapy include DCIS grade, tumour size, width of the margin of normal tissue and patient age.…”

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confidence: 99%

Copy number analysis of ductal carcinoma in situ with and without recurrence

et al. 2015

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Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer and a frequent mammographic finding requiring treatment. Up to 25% of DCIS can recur and half of recurrences are invasive, but there are no reliable biomarkers for recurrence. We hypothesised that copy number aberrations could predict likelihood of recurrence. We analysed a cohort of pure DCIS cases treated only with wide local excision for genome-wide copy number and loss of heterozygosity using Affymetrix OncoScan MIP arrays. Cases included those without recurrence within 7 years (n = 25) and with recurrence between 1 and 5 years after diagnosis (n = 15). Pure DCIS were broadly similar in copy number changes compared with invasive breast cancer, with the consistent exception of a greater frequency of ERBB2 amplification in DCIS. There were no significant differences in age or ER status between the cases with a recurrence vs those without. Overall, the DCIS cases with recurrence had more copy number events than the DCIS without recurrence. The increased copy number appeared non-random with several genomic regions showing an increase in frequency in recurrent cases, including 20q gain, ERBB2 amplification and 15q loss. Copy number changes may provide prognostic information for DCIS recurrence, but validation in additional cohorts is required. Modern Pathology (2015Pathology ( ) 28, 1174Pathology ( -1184 doi:10.1038/modpathol.2015 published online 19 June 2015 Ductal carcinoma in situ (DCIS) is a proliferation of malignant cells within breast ducts without invasion through the basement membrane. A number of lines of evidence demonstrate that DCIS is a non-obligate precursor of invasive breast cancer, including the natural history of untreated DCIS, 1 the high risk of ipsilateral invasive breast cancer after a diagnosis of DCIS and the common clonal genetic events found in DCIS and synchronous or recurrent invasive breast cancer. 2 Prior to population-based screening mammography, DCIS was an unusual finding comprising only 3-5% of all breast neoplasms. Currently,~20% of cases of screen-detected breast neoplasia are DCIS. 3 Standard treatment has become wide local excision of DCIS with or without adjuvant radiotherapy. 4 Recent clinical trials have found that~25% of DCIS treated with local excision only will recur within 15 years, with the greatest risk of recurrence in the first 5 years. 5 Approximately half of the recurrences will be invasive carcinoma, requiring more extensive treatment, and with a possible decrease in disease-specific survival. 6 Radiotherapy reduces the recurrence rate by about 50%, so despite the fact that only small a small proportion of patients will benefit, many clinicians recommend radiotherapy because of the implications of invasive recurrence. The most commonly used predictive models to estimate the recurrence risk with or without radiotherapy include DCIS grade, tumour size, width

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confidence: 99%

Copy number analysis of ductal carcinoma in situ with and without recurrence

et al. 2015

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“…(6,7,14,15,16) Overall, mortality from DCIS is low, regardless of chosen treatment, with 10-year risk of death as a result of invasive breast cancer ranging from 1.0 to 2.6%. (33) Cumulative breast cancer specific death (BCSD) incidence at 20 years was 4.1% in the RT arm and 4.2% in the control arm in the randomized SweDCIS Trial.…”

Section: Selection Of "Good Risk" Patientsmentioning

confidence: 99%

“…(6,7,14,15) The Early Breast Cancer Trialists Collaborative Group (EBCTG) meta-analysis performed on 3,729 patients enrolled in these four randomized trials showed that RT reduced the absolute 10-year risk of any ipsilateral breast event (either recurrent DCIS or invasive cancer) by 15 Even for 291 women with low risk (negative margins and small low grade tumorous) the absolute reduction in the 10-year risk of ipsilateral breast events was 18% (12.1 vs 30.1%; 2 p > 0.002).…”

Section: Dcis With Microcalcificationsmentioning

confidence: 99%

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Radiation Therapy Following Breast Conserving Surgery for Ductal Carcinoma in situ: Yes or No?

Stoleru¹,

Stoleru²

2017

chr

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RezumatCarcinomul ductal in situ al sânului este un precursor non-invaziv al cancerului mamar şi este reprezentat de un grup de leziuni cu potenţial malign variabil. Tratamentul local optim pentru pacientele cu carcinom ductal in situ rãmane un subiect controversat, în ciuda rezultatelor provenite din mai multe trialuri randomizate. Radioterapia care urmeazã intervenţiei chirurgicale conservatoare reduce aproximativ la jumãtate riscul de recidivã localã, dar nu are impact în ceea ce priveşte supravieţuirea pe termen lung. Studiile clinice desfãşurate pânã în prezent nu au putut identifica un subgrup de paciente cu carcinom ductal in situ cu risc scãzut, la care sã se poata renunţa în siguranţã la radioterapie, dupã intervenţia chirurgicala conservatoare. În lucrare sunt prezentate rezultate ale studiilor clinice în care s-a utilizat chirurgia conservatoare a sânului urmatã sau nu de radioterapie. Alte subiecte abordate se referã la stabilirea indicaţiei terapeutice în cazul carcinomului ductal in situ cu risc scãzut şi la noi tendinţe în radioterapia pentru carcinomul ductal in situ. Review Articlebreast cancerand represents a heterogenous group of lesions with different malignant potential. Despite several randomized trials, there is still controversy regarding the optimal local treatment for DCIS patients. The addition of radiotherapy after breast conserving surgery approximately halves the local recurrence risk but has no impact on long-term survival. Clinical studies failed to identify a low risk subgroup of DCIS patients treated with breast conserving surgery in whom radiotherapy can be safely omitted. Results of clinical trials of breast conserving surgery ± radiotherapy are summarized. Treatment decision making in low risk DCIS and current tendencies in the radiotherapy for DCIS are other issues addressed in this paper.

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“…For women undergoing BCS, all randomized controlled trials (RTCs) have demonstrated that adjuvant radiotherapy (RT) reduces the risk of LR after adequate local excision of localized disease [4][5][6] . A recent update from the NSABP B-17 and NSABP B-24 trials [4] has demonstrated that adjuvant RT is associated with a significantly lower LR rate after a median follow up of 15 years.…”

Section: Adjuvant Treatmentsmentioning

confidence: 99%

Towards optimal treatment of ductal carcinoma in situ

Choy

Mokbel

2014

WJCO

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Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer with a variable biological behavior which is difficult to accurately predict using the current clinico-pathological parameters. Randomized controlled trials have demonstrated that adjuvant radiotherapy (RT) reduces the risk of local recurrence after adequate local excision of DCIS. Tamoxifen may be considered as an adjuvant endocrine treatment in patients with high risk estrogen receptor positive disease. There is however a growing consensus that RT can be safely omitted in a subgroup of patients with favorable biological features in order to avoid overtreatment. The sentinel node biopsy is not routinely indicated but should be considered in women undergoing mastectomy for DCIS. The discovery of molecular signatures that accurately predict the biological behavior of this common malignancy will facilitate a personalized treatment approach in the future.

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Breast-Conserving Treatment With or Without Radiotherapy in Ductal Carcinoma In Situ: 15-Year Recurrence Rates and Outcome After a Recurrence, From the EORTC 10853 Randomized Phase III Trial

Abstract: At 15 years, almost one in three nonirradiated women developed an LR after LE for DCIS. RT reduced this risk by a factor of 2. Although women who developed an invasive recurrence had worse survival, the long-term prognosis was good and independent of the given treatment.

Cited by 322 publications

References 23 publications

Copy number analysis of ductal carcinoma in situ with and without recurrence

Copy number analysis of ductal carcinoma in situ with and without recurrence

Radiation Therapy Following Breast Conserving Surgery for Ductal Carcinoma in situ: Yes or No?

Towards optimal treatment of ductal carcinoma in situ

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