Radiotherapy of Ductal Carcinoma In Situ

Abstract

Ductal carcinoma in situ (DCIS) is a heterogeneous disease in both its biology and clinical course. In the past, recurrence rates after breast-conserving surgery have been as high as 30% after 10 years. The introduction of mammography screening and advances in imaging have led to an increase in the detection of DCIS. The focus of this review is on the role of radiotherapy in the multidisciplinary treatment, including current developments in hypofractionation and boost delivery, and attempts to define low-risk subsets of DCIS for which the need for adjuvant radiation is repeatedly questioned.

Hypofractionation with concomitant boost using intensity-modulated radiation therapy in early-stage breast cancer in Mexico

“…HF has been demonstrated to be a safe, effective and a tolerable treatment strategy. [14][15][16][17][18] The boost to the tumour bed has been completely demonstrated to reduce LR in patients with invasive breast cancer [5][6][7][8][9][10] ; intensifying the treatment by giving a boost to the tumour bed is not standard for patients with DCIS, and its use has been questioned. The results of retrospective studies demonstrate a reduction in the LR (3-6%) and a life expectancy greater than 10 years.…”

“…Regarding conventional RT to the breast and concomitant boost to the tumour bed, there are few studies, and most of these are institutional [11][12][13][14][15] ; these studies used fractions of 1.6-1.8 Gy with total doses of 45-51 Gy to the mammary gland and doses of 2.3-2.4 Gy per fraction (Fx) to the tumour bed for total doses of 60-73 Gy.…”

Verzicht auf die adjuvante Radiotherapie beim duktalen Carcinoma in situ

“…Dies ließe eine Interpretation zu, dass Patientinnen, die bestrahlt werden, nicht ausreichend vom medizinischen Fortschritt profitieren. Wahrscheinlicher ist allerdings, dass eine zunehmende Patientenselektion zugunsten einer alleinigen Tumorexzision unter Brusterhalt erfolgte und die RT die negativen Prognosefaktoren kompensiert [5].…”

Current controversies in radiotherapy for breast cancer

“…Several groups have tried to establish a definition of a low risk-group of patients in which adjuvant radiotherapy after breast-conserving surgery could safely be omitted using clinical, pathological and molecular parameters. However there is no consensus on which factors should be used (for review see [42]).…”