Ipsilateral tumor recurrence risk in women with ductal carcinoma in situ: application of the Van Nuys Prognostic Index and the Memorial Sloan Kettering Cancer Center nomogram

Hashiba, Kimberlee A.; Bahl, Manisha

doi:10.1007/s10549-023-07036-5

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…This result could probably be correlated with the short follow-up of our study, which is one of the limitations of the study. Certainly, younger patients had a longer life expectancy, and the risk of LRR is higher [33,34].…”

Section: Discussionmentioning

confidence: 99%

Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS

Vanni,

Pellicciaro,

Di Lorenzo

et al. 2024

Cancers

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The current surgical guidelines recommend an optimal margin width of 2 mm for the management of patients diagnosed with ductal carcinoma in situ (DCIS). However, there are still many controversies regarding re-excision when the optimal margin criteria are not met in the first resection. The purpose of this study is to understand the importance of surgical margin width, re-excision, and treatments to avoid additional surgery on locoregional recurrence (LRR). The study is retrospective and analyzed surgical margins, adjuvant treatments, re-excision, and LRR in patients with DCIS who underwent breast-conserving surgery (BCS). A total of 197 patients were enrolled. Re-operation for a close margin rate was 13.5%, and the 3-year recurrence was 7.6%. No difference in the LRR was reported among the patients subjected to BCS regardless of the margin width (p = 0.295). The recurrence rate according to margin status was not significant (p = 0.484). Approximately 36.9% (n: 79) patients had resection margins < 2 mm. A sub-analysis of patients with margins < 2 mm showed no difference in the recurrence between the patients treated with a second surgery and those treated with radiation (p = 0.091). The recurrence rate according to margin status in patients with margins < 2 mm was not significant (p = 0.161). The margin was not a predictive factor of LRR p = 0.999. Surgical re-excision should be avoided in patients with a focally positive margin and no evidence of the disease at post-surgical imaging.

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Section: Discussionmentioning

confidence: 99%

Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS

Vanni,

Pellicciaro,

Di Lorenzo

et al. 2024

Cancers

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“…Well-known CPFs (age, grade, size, margins, multifocality, comedonecrosis, palpable presentation, hormonal receptor status, receipt of endocrine therapy, and comorbidities) [51,99,141] have been included in several nomograms to predict the LR risk with and without WBRT. The clinical utility is controversial since the linear algorithms behind the nomograms singularly weighted the parameters and do not consider the molecular interdependency [142,143]. To increase the predictive accuracy, the CPFs are combined with biomarkers and genomic assay [144][145][146][147].…”

Section: Decision Support Tools: Traditional Prediction Modelsmentioning

confidence: 99%

Tools to Guide Radiation Oncologists in the Management of DCIS

Leonardi,

Zerella,

Lazzeroni

et al. 2024

Healthcare

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Similar to invasive breast cancer, ductal carcinoma in situ is also going through a phase of changes not only from a technical but also a conceptual standpoint. From prescribing radiotherapy to everyone to personalized approaches, including radiotherapy omission, there is still a lack of a comprehensive framework to guide radiation oncologists in decision making. Many pieces of the puzzle are finding their place as high-quality data mature and are disseminated, but very often, the interpretation of risk factors and the perception of risk remain very highly subjective. Sharing the therapeutic choice with patients requires effective communication for an understanding of risks and benefits, facilitating an informed decision that does not increase anxiety and concerns about prognosis. The purpose of this narrative review is to summarize the current state of knowledge to highlight the tools available to radiation oncologists for managing DCIS, with an outlook on future developments.

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“…7 Unfortunately, current predictive models are insufficient in this respect as prospective studies using clinicopathologic factors alone have not clearly identified a 'low-risk' DCIS cohort who do not clinically benefit from RT, and low-risk DCIS patients still showed a 70-80% reduction in IBR risk with RT. 4,[11][12][13][14]21 To assess DCIS recurrence risk and to predict the benefit of the treatment, it is imperative to identify and validate methods that combine clinical/pathological features with new molecular factors. 15 The reproducibility, predictive ability, and clinical utility of such a test are considerations necessary to support its clinical use.…”

Section: Abstract Ductal Carcinoma In Situ • Radiation Therapy • Deci...mentioning

confidence: 99%

The Clinical Utility of a 7-Gene Biosignature on Radiation Therapy Decision Making in Patients with Ductal Carcinoma In Situ Following Breast-Conserving Surgery: An Updated Analysis of the DCISionRT® PREDICT Study

Shah,

Whitworth,

Vicini

et al. 2024

Ann Surg Oncol

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Background Breast-conserving surgery (BCS) followed by adjuvant radiotherapy (RT) is a standard treatment for ductal carcinoma in situ (DCIS). A low-risk patient subset that does not benefit from RT has not yet been clearly identified. The DCISionRT test provides a clinically validated decision score (DS), which is prognostic of 10-year in-breast recurrence rates (invasive and non-invasive) and is also predictive of RT benefit. This analysis presents final outcomes from the PREDICT prospective registry trial aiming to determine how often the DCISionRT test changes radiation treatment recommendations. Methods Overall, 2496 patients were enrolled from February 2018 to January 2022 at 63 academic and community practice sites and received DCISionRT as part of their care plan. Treating physicians reported their treatment recommendations pre- and post-test as well as the patient’s preference. The primary endpoint was to identify the percentage of patients where testing led to a change in RT recommendation. The impact of the test on RT treatment recommendation was physician specialty, treatment settings, individual clinical/pathological features and RTOG 9804 like criteria. Multivariate logisitc regression analysis was used to estimate the odds ratio (ORs) for factors associated with the post-test RT recommendations. Results RT recommendation changed 38% of women, resulting in a 20% decrease in the overall recommendation of RT (p < 0.001). Of those women initially recommended no RT (n = 583), 31% were recommended RT post-test. The recommendation for RT post-test increased with increasing DS, from 29% to 66% to 91% for DS <2, DS 2–4, and DS >4, respectively. On multivariable analysis, DS had the strongest influence on final RT recommendation (odds ratio 22.2, 95% confidence interval 16.3–30.7), which was eightfold greater than clinicopathologic features. Furthermore, there was an overall change in the recommendation to receive RT in 42% of those patients meeting RTOG 9804-like low-risk criteria. Conclusions The test results provided information that changes treatment recommendations both for and against RT use in large population of women with DCIS treated in a variety of clinical settings. Overall, clinicians changed their recommendations to include or omit RT for 38% of women based on the test results. Based on published clinical validations and the results from current study, DCISionRT may aid in preventing the over- and undertreatment of clinicopathological ‘low-risk’ and ‘high-risk’ DCIS patients. Trial Registration ClinicalTrials.gov identifier: NCT03448926 (https://clinicaltrials.gov/study/NCT03448926).

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Ipsilateral tumor recurrence risk in women with ductal carcinoma in situ: application of the Van Nuys Prognostic Index and the Memorial Sloan Kettering Cancer Center nomogram

Cited by 3 publications

References 24 publications

Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS

Surgical De-Escalation for Re-Excision in Patients with a Margin Less Than 2 mm and a Diagnosis of DCIS

Tools to Guide Radiation Oncologists in the Management of DCIS

The Clinical Utility of a 7-Gene Biosignature on Radiation Therapy Decision Making in Patients with Ductal Carcinoma In Situ Following Breast-Conserving Surgery: An Updated Analysis of the DCISionRT® PREDICT Study

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