Use of the Twelve-Gene Recurrence Score for Ductal Carcinoma in Situ and Its Influence on Receipt of Adjuvant Radiation and Hormonal Therapy

Overcoming Barriers in Ductal Carcinoma In Situ Management: From Overtreatment to Optimal Treatment

“…63 This and other series suggest that the use of a risk score may affect RT recommendations beyond routinely available CPF, yet neither assay has been prospectively tested in randomized trials, which may explain their low penetration in routine care. 64 The wide range of dose-fractionation and shorter treatment schedules available in DCIS further complicate studies assessing RT. In the setting of whole breast irradiation, moderately hypofractionated schedules of 15-20 treatments are now preferred over more protracted courses.…”

“…63 This and other series suggest that the use of a risk score may affect RT recommendations beyond routinely available CPF, yet neither assay has been prospectively tested in randomized trials, which may explain their low penetration in routine care. 64…”

Tools to Guide Radiation Oncologists in the Management of DCIS

“…Interestingly, when weighing the impact of different variables on decision making, the DCIS score was rated as the most impactful, followed by pathologic features, patients' preferences, age, and comorbidities [172]. Data from the National Cancer Database (NCDB) from 2010 to 2016 showed that the use of the DCIS score increased over time, especially for those with favourable features for whom a low-risk score significantly reduced RT recommendations [173]. Among patients, the assay also reduced anxiety and decisional conflict [14,169].…”

Update Breast Cancer 2021 Part 3 – Current Developments in the Treatment of Early Breast Cancer: Review and Assessment of Specialised Treatment Scenarios by an International Expert Panel

“…The interesting finding here is that the panellists also considered a low biological or genomic risk, as established by a multigene assay, to be an indicator for not performing radiation therapy (Supplementary Table S1; questions 106-111). An analysis published this year likewise finds that the use of multigene assays is increasing and that this is reducing the number of patients at a low genomic risk undergoing radiotherapy for DCIS [12], even if this finding has not yet been established in a prospective study. Interestingly, a majority of panellists rejected the use of multigene signatures for the various radiation therapy scenarios to treat invasive carcinoma (Supplementary Table S1, questions [65][66][67].…”

“…genomisches Risiko in einem Multigenassay als Indikator gewertet wurde, der den Verzicht auf eine Radiatio nahelegt (Supplementary Table S1 ; Fragen 106 – 111). In einer in diesem Jahr publizierten Analyse zeigt sich konsequenterweise auch, dass der Einsatz von Multigenassays zunimmt und dass dies zu einer Deeskalation der Strahlentherapie beim DCIS in Fällen von niedrigem genomischen Risiko führt 12 , auch wenn dies bislang nicht in einer prospektiven Studie untersucht wurde. Interessanterweise wurde für das invasive Karzinom der Einsatz von Multigensignaturen zur Indikationsstellung für verschiedene Bestrahlungsszenarien durch das St.-Gallen-Panel klar abgelehnt (Supplementary Table S1 , Fragen 65 – 67).…”