Treatment results in patients with ductal carcinoma in situ treated with adjuvant radiotherapy
Treatment results in patients with ductal carcinoma in situ treated with adjuvant radiotherapy
Background/aim: The aim of this study was to evaluate the treatment results of patients undergoing adjuvant radiotherapy (ART) afterbreast surgery with the diagnosis of ductal carcinoma in situ (DCIS).Materials and methods: A total of 61 women who had undergone radiotherapy following extensive surgical excision were enrolled. Allpatients underwent 50 Gy ART. Survival analysis was performed using Kaplan–Meier analysis and SPSS 20.0.Results: The median age was 52 years (range: 28–86). The median follow-up period after RT was 92 months (range: 23–237). Themedian overall survival and distant and regional recurrence-free and disease-specific survival was 96 months (range: 26–240), whiledisease-free and local recurrence-free survival was 96 months (range: 22–240). While the 15-year and 20-year overall survival rates were87% and 87%, respectively, the recurrence-free survival rates were 98% and 98%, respectively; the rates of disease-specific survival were100% and 100%, respectively.Conclusion: The results of this study with a long follow-up period have shown that ART in DCIS is an effective treatment method toprovide local disease control. However, further large studies are needed to identify the prognostic factors.
___
- 1. Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A et al.
American Cancer Society. Cancer statistics, 2004. CA Cancer
Journal for Clinicians 2004; 54 (1): 8-29.
- 2. Siegel RL, Miller KD, Jemal A. Cancer statistics 2015. CA Cancer
Journal for Clinicians 2015; 65 (1): 5-29. doi: 10.3322/caac.21254.
- 3. Trentham-Dietz A, Newcomb PA, Storer BE, Remington PL. Risk
factors for carcinoma in situ of the breast. Cancer Epidemiology
Biomarkers and Prevention 2000; 9: 697-703.
- 4. Page DL, Rogers LW. Combined histologic and cytologic criteria
for the diagnosis of mammary atypical ductal hyperplasia.
Human Pathology 1992; 23 (10): 1095-1097.
- 5. Badve S, A’Hern RP, Ward AM, Millis RR, Pinder SE et al.
Prediction of local recurrence of ductal carcinoma in situ of the
breast using five histological classifications: a comparative study
with long follow-up. Human Pathology 1998; 29 (9): 915-923.
- 6. Millis RR, Thynne GSJ. In situ intraduct carcinoma of the breast:
a long-term follow-up study. British Journal of Surgery 1975; 62:
957-962.
- 7. Sanders ME, Schuyler PA, Dupont WD, Page DL. The natural
history of low-grade ductal carcinoma in situ of the breast in
women treated by biopsy only revealed over 30 years of longterm follow-up. Cancer 2005; 103: 2481-2484. doi: 10.1002/
cncr.21069
- 8. O’Sullivan MJ, Morrow M. Ductal carcinoma in situ—current
management. Surgical Clinics of North America 2007; 87 (2):
333-351. doi: 10.1016/j.suc.2007.01.006
- 9. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M et al.
Twenty-year follow-up of a randomized trial comparing total
mastectomy, lumpectomy, and lumpectomy plus irradiation
for the treatment of invasive breast cancer. New England
Journal of Medicine 2002; 347 (16): 1233-1241. doi: 10.1056/
NEJMoa022152
- 10. Van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ
et al. Long-term results of a randomized trial comparing breastconserving therapy with mastectomy: European Organization
for Research and Treatment of Cancer 10801 trial. Journal of
National Cancer Institute 2000; 92 (14): 1143-1150. doi: 10.1093/
jnci/92.14.1143
- 11. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R et al.
Twenty-year follow-up of a randomized study comparing breastconserving surgery with radical mastectomy for early breast
cancer. New England Journal of Medicine 2002; 347 (16): 1227-
1232. doi: 10.1056/NEJMoa020989
- 12. Goodwin A, Parker S, Ghersi D, Wilcken N. Post-operative
radiotherapy for ductal carcinoma in situ of the breast—a
systematic review of the randomised trials. Breast 2009; 18 (3):
143-149. doi: 10.1016/j.breast.2009.04.003
- 13. Fisher B, Land S, Mamounas E, Dignam J, Fisher ER et al.
Prevention of invasive breast cancer in women with ductal
carcinoma in situ: an update of the National Surgical Adjuvant
Breast and Bowel Project experience. Seminars in Oncology
2001; 28 (4): 400-418.
- 14. EORTC Breast Cancer Cooperative Group; EORTC
Radiotherapy Group; Bijker N, Meijnen P, Peterse JL et al.
Breast-conserving treatment with or without radiotherapy
in ductal carcinoma-in-situ: ten-year results of European
Organisation for Research and Treatment of Cancer
randomized phase III trial 10853-A study by the EORTC
Breast Cancer Cooperative Group and EORTC Radiotherapy
Group. Journal of Clinical Oncology 2006; 24 (21): 3381-3387.
doi: 10.1200/JCO.2006.06.1366
- 15. Houghton J, George WD, Cuzick J, Duggan C, Fentiman IS et
al. UK Coordinating Committee on Cancer Research; Ductal
Carcinoma in situ Working Party; DCIS trialists in the UK,
Australia, and New Zealand. Radiotherapy and tamoxifen in
women with completely excised ductal carcinoma in situ of the
breast in the UK, Australia, and New Zealand: Randomised
controlled trial. Lancet 2003; 362 (9378): 95-102.
- 16. Holmberg L, Garmo H, Granstrand B, Ringberg A, Arnesson
LG et al. Absolute risk reductions for local recurrence after
postoperative radiotherapy after sector resection for ductal
carcinoma in situ of the breast. Journal of Clinical Oncology
2008; 26 (8): 1247-1252.
- 17. Burstein HJ, Polyak K, Wong JS, Lester SC, Kaelin CM. Ductal
carcinoma in situ of the breast. New England Journal of
Medicine 2004; 350: 1430-1441. doi: 10.1056/NEJMra031301
- 18. Silverstein MJ. The University of Southern California/Van
Nuys prognostic index for ductal carcinoma in situ of the
breast. American Journal of Surgery 2003; 186 (4): 337-343.
- 19. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation
Therapy Oncology Group (RTOG) and the European
Organization for Research and Treatment of Cancer (EORTC).
International Journal of Radiation Oncology, Biology, Physics
1995; 31 (5): 1341-1346. doi: 10.1016/0360-3016(95)00060-C
- 20. Harris JR, Levene MB, Svensson G, Hellman S. Analysis of
cosmetic results following primary radiation therapy for stages
I and II carcinoma of the breast. International Journal of
Radiation Oncology, Biology, Physics 1979; 5: 257-261.
- 21. Brinton LA, Sherman ME, Carreon JD, Anderson WF. Recent
trends in breast cancer among younger women in the United
States. Journal of National Cancer Institute 2008; 100 (22):
1643-1648. doi: 10.1093/jnci/djn344
- 22. Hwang ES. The impact of surgery on ductal carcinoma in situ
outcomes: the use of mastectomy. Journal of National Cancer
Institute Monographs 2010; 2010 (41): 197-199. doi: 10.1093/
jncimonographs/lgq032
- 23. Fisher ER, Leeming R, Anderson S, Redmond C, Fisher B.
Conservative management of intraductal carcinoma (DCIS) of
the breast. Journal of Surgical Oncology 1991; 47: 139-147.
- 24. Wapnir IL, Dignam JJ, Fisher B, Mamounas EP, Anderson
SJ et al. Long-term outcome of invasive ipsilateral breast
tumor recurrences after lumpectomy in NSABP-17 and B-24
randomized clinical trials for DCIS. Journal of National Cancer
Institute 2011; 103: 478-488. doi: 10.1093/jnci/djr027
- 25. Ernster VL, Barclay J, Kerlikowske K, Wilkie H, BallardBarbash R. Mortality among women with ductal carcinoma
in situ of the breast in the population-based surveillance,
epidemiology and end results program. Archives of Internal
Medicine 2000; 160 (7): 953-958.
- 26. Motwani SB, Goyal S, Moran MS, Chhabra A, Haffty BG. Ductal
carcinoma in situ treated with breast-conserving surgery and
radiotherapy: a comparison with ECOG study 5194. Cancer
2011; 117 (6): 1156-1162. doi: 10.1002/cncr.25623
- 27. Manders JB, Kuerer HM, Smith BD, McCluskey C, Farrar WB
et al. Clinical utility of the 12-Gene DCIS Score Assay: impact
on radiotherapy recommendations for patients with ductal
carcinoma in situ. Annals of Surgical Oncology 2017; 24 (3):
660-668. doi: 10.1245/s10434-016-5583-7
- 28. Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van
den Bogaert W et al. Impact of a higher radiation dose on
local control and survival in breast-conserving therapy of early
breast cancer: 10-year results of the randomized boost versus no
boost EORTC 22881-10882 trial. Journal of Clinical Oncology
2007; 25 (22): 3259-3265. doi: 10.1200/JCO.2007.11.4991
- 29. Romestaing P, Lehingue Y, Carrie C, Coquard R, Montbarbon
X et al. Role of a 10-Gy boost in the conservative treatment
of early breast cancer: results of a randomized clinical trial in
Lyon, France. Journal of Clinical Oncology 1997; 15 (3): 963-
968. doi: 10.1200/JCO.1997.15.3.963
- 30. Moran MS, Zhao Y, Ma S, Kirova Y, Fourquet A et al. Association
of radiotherapy boost for ductal carcinoma in situ with local
control after whole-breast radiotherapy. JAMA Oncology 2017;
3 (8): 1060-1068. doi: 10.1001/jamaoncol.2016.6948
- 31. Wong P, Lambert C, Agnihotram RV, David M, Duclos M et
al. Ductal carcinoma in situ—the influence of the radiotherapy
boost on local control. International Journal of Radiation
Oncology, Biology, Physics 2012; 82 (2): e153-e158. doi:
10.1016/j.ijrobp.2011.03.045
- 32. Shapiro-Wright HM, Julian TBJ. Sentinel lymph node biopsy
and management of the axilla in ductal carcinoma in situ.
National Cancer Institute Monographs 2010; 2010 (41): 145-
149. doi: 10.1093/jncimonographs/lgq026
- 33. Fisher B, Bryant J, Dignam JJ, Wickerham DL, Mamounas
EP et al. National Surgical Adjuvant Breast and Bowel
Project. Tamoxifen, radiation therapy, or both for prevention
of ipsilateral breast tumor recurrence after lumpectomy in
women with invasive breast cancers of one centimeter or less.
Journal of Clinical Oncology 2002; 20 (20): 4141-4149. doi:
10.1200/JCO.2002.11.101
- 34. Fisher B, Dignam J, Wolmark N, Wickerham DL, Fisher ER
et al. Tamoxifen in treatment of intraductal breast cancer.
National Surgical Adjuvant Breast and Bowel Project B-24
randomised controlled trial. Lancet 1999; 353 (9169): 1993-
2000. doi: 10.1016/S0140-6736(99)05036-9
- 35. START Trialists’ Group; Bentzen SM, Agrawal RK, Aird EG,
Barrett JM et al. The UK Standardisation of Breast Radiotherapy
(START) Trial A of radiotherapy hypofractionation for
treatment of early breast cancer: a randomised trial.
Lancet Oncology 2008; 9 (4): 331-341. doi: 10.1016/S1470-
2045(08)70077-9
- 36. START Trialists’ Group; Bentzen SM, Agrawal RK, Aird EG,
Barrett JM et al. The UK Standardisation of Breast Radiotherapy
(START) Trial B of radiotherapy hypofractionation for
treatment of early breast cancer: a randomised trial.
Lancet 2008; 371 (9618): 1098-1107. doi: 10.1016/S0140-
6736(08)60348-7
- 37. Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R et
al. Long-term results of hypofractionated radiation therapy for
breast cancer. New England Journal of Medicine 2010; 362 (6):
513-520. doi: 10.1056/NEJMoa0906260.
- 38. Lalani N, Paszat L, Sutradhar R, Thiruchelvam D, NofechMozes S et al. Long-term outcomes of hypofractionation versus
conventional radiation therapy after breast-conserving surgery
for ductal carcinoma in situ of the breast. International Journal
of Radiation Oncology, Biology, Physics 2014; 90 (5): 1017-
1024. doi: 10.1016/j.ijrobp.2014.07.026
- 39. Wai ES, Lesperance ML, Alexander CS, Truong PT, Culp M
et al. Effect of radiotherapy boost and hypofractionation on
outcomes in ductal carcinoma in situ. Cancer 2011; 117 (1):
54-62. doi: 10.1002/cncr.25344.40
- 40. Williamson D, Dinniwell R, Fung S, Pintilie M, Done SJ et
al. Local control with conventional and hypofractionated
adjuvant radiotherapy after breast-conserving surgery for
ductal carcinoma in-situ. Radiotherapy and Oncology: Journal
of European Society for Therapeutic Radiology and Oncology
2010; 95 (3): 317-320. doi: 10.1016/j.radonc.2010.03.021