Role of postoperative radiotherapy in reducing ipsilateral recurrence in DCIS: an observational study of 1048 cases

Corradini, Stefanie; Pazos, Montserrat; Schönecker, S.; Reitz, D.; Niyazi, Maximilian; Ganswindt, Ute; Schrodi, Simone; Braun, Michael; Pölcher, Martin; Mahner, Sven; Harbeck, Nadia; Engel, Jutta; Belka, Claus

doi:10.1186/s13014-018-0964-7

Cited by 13 publications

(13 citation statements)

References 28 publications

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“…Despite these results, the use of RT after BCS varies considerably between countries. For instance, a study in Japan showed only 41% of RT use after BCS, whereas other series in the UK, 10 Queensland, 32 and Munich 30 showed 62%, 62%, and 66% rates, respectively, with similar rates in the ICSN multicenter study. 25 A study conducted in the Navarra region of Spain reported a 100% RT rate.…”

Section: Bruno Cutuli Et Almentioning

confidence: 93%

“…Table 5 shows the results of randomized trials and several large retrospective studies confirming the place of RT in reduction of LR rates after BCS. 5,6,15,[28][29][30] The meta-analysis showed that approximately 50% of LRs were invasive. 31 The benefit of RT increases with time, as the overall absolute LR reduction was 10.5% at 5 years and 15.2% at 10 years (from 28.1% to 12.9%; log rank P < .0001).…”

Section: Bruno Cutuli Et Almentioning

confidence: 99%

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Ductal Carcinoma in Situ: A French National Survey. Analysis of 2125 Patients

Cutuli

Lemanski

Lafontan

et al. 2020

Clinical Breast Cancer

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This was an analysis of 2125 ductal carcinoma in situ features/treatments from 71 French centers. Mastectomy and breast-conserving surgery was performed in 25% and 75% of cases, respectively; the median tumor size was 15 mm, and the low, intermediate, and high nuclear grade distribution was 12%, 36%, and 47%, respectively. After breast-conserving surgery, 97% underwent whole breast irradiation. This survey reflects the daily ductal carcinoma in situ treatment in France, and the results are in accordance with national guidelines. Background: Ductal carcinoma in situ (DCIS) represents 15% of all breast cancers in France. The first national survey was conducted in 2003. The present multi-center real-life practice survey aimed at assessing possible changes in demographic, clinical, pathologic, and treatment features. Material and Methods: From March 2014 to September 2015, patients diagnosed with DCIS from 71 centers with complete information about age, diagnostic features, and treatment modalities were prospectively included. Results: A total of 2125 patients with a median age of 58.6 years from 71 centers were studied. DCIS was diagnosed by mammography in 87.5% of cases. Preoperative biopsy was performed in 96% of cases. The median tumor size was 15 mm. Nuclear grade was low, intermediate, and high in 12%, 36%, and 47% of cases, respectively. Margins were considered to be negative in 83% of cases. Overall mastectomy and lumpectomy rates were 25% and 75%, respectively. The immediate breast reconstruction rate was 50%. Sentinel node biopsy and axillary dissection rates were 41% and 2.6%, respectively. After lumpectomy, 97% of patients underwent radiotherapy, and 32% received a boost dose. Only 1% of patients received endocrine therapy. Compared with our previous survey, the median tumor size remained the same, and the proportion of high-grade lesions increased by 9%. The mastectomy rate decreased by 4%. Conclusions: The clinical practice identified in this survey complies with French DCIS guidelines. About 10% of patients with low-grade DCIS may be eligible to participate in treatment de-escalation trials.

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Section: Bruno Cutuli Et Almentioning

confidence: 93%

Section: Bruno Cutuli Et Almentioning

confidence: 99%

Ductal Carcinoma in Situ: A French National Survey. Analysis of 2125 Patients

Cutuli

Lemanski

Lafontan

et al. 2020

Clinical Breast Cancer

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“…Although previous studies provided evidence for a possible survival benefit in intermediate-risk patients [41], PMRT was not uniformly recommended at that time. The standard RT regimen at the Department of Radiation Oncology of the LMU Munich during the observation period was whole-breast irradiation following BCS (50.4 Gy in 28 fractions) using a 3-dimensional conformal tangential field technique with a photon or electron boost of 10–16 Gy to the tumor bed [42].…”

Section: Methodsmentioning

confidence: 99%

Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Corradini

Reitz

Pazos

et al. 2019

Cancers

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Although the organ preservation strategy by breast-conserving surgery (BCS) followed by radiation therapy (BCT) has revolutionized the treatment approach of early stage breast cancer (BC), the choice between treatment options in this setting can still vary according to patient preferences. The aim of the present study was to compare the oncological outcome of mastectomy versus breast-conserving therapy in patients treated in a modern clinical setting outside of clinical trials. 7565 women diagnosed with early invasive BC (pT1/2pN0/1) between 1998 and 2014 were included in this study (median follow-up: 95.2 months). In order to reduce selection bias and confounding, a subgroup analysis of a matched 1:1 case-control cohort consisting of 1802 patients was performed (median follow-up 109.4 months). After adjusting for age, tumor characteristics and therapies, multivariable analysis for local recurrence-free survival identified BCT as an independent predictor for improved local control (hazard ratio [HR]:1.517; 95%confidence interval:1.092–2.108, p = 0.013) as compared to mastectomy alone in the matched cohort. Ten-year cumulative incidence (CI) of lymph node recurrences was 2.0% following BCT, compared to 5.8% in patients receiving mastectomy (p < 0.001). Similarly, 10-year distant-metastasis-free survival (89.4% vs. 85.5%, p = 0.013) was impaired in patients undergoing mastectomy alone. This translated into improved survival in patients treated with BCT (10-year overall survival (OS) estimates 85.3% vs. 79.3%, p < 0.001), which was also significant on multivariable analysis (p = 0.011). In conclusion, the present study showed that patients treated with BCS followed by radiotherapy had an improved outcome compared to radical mastectomy alone. Specifically, local control, distant control, and overall survival were significantly better using the conservative approach. Thus, as a result of the present study, physicians should encourage patients to receive BCS with radiotherapy rather than mastectomy, whenever it is medically feasible and appropriate.

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“…Adding radiotherapy to breast-conserving treatment reduces local recurrence rates but does not influence overall survival or breast-cancer-specific survival. 27,45,46 The added value of conducting a sentinel node biopsy procedure is uncertain. In general, such a procedure is done with mastectomy for DCIS (since there is no opportunity to perform a subsequent sentinel node biopsy) or where there is a high suspicion for invasive disease even where DCIS alone is present in the preoperative biopsy.…”

Section: Treatment Of Dcismentioning

confidence: 99%

Ductal carcinoma in situ: to treat or not to treat, that is the question

et al. 2019

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Ductal carcinoma in situ (DCIS) now represents 20–25% of all ‘breast cancers’ consequent upon detection by population-based breast cancer screening programmes. Currently, all DCIS lesions are treated, and treatment comprises either mastectomy or breast-conserving surgery supplemented with radiotherapy. However, most DCIS lesions remain indolent. Difficulty in discerning harmless lesions from potentially invasive ones can lead to overtreatment of this condition in many patients. To counter overtreatment and to transform clinical practice, a global, comprehensive and multidisciplinary collaboration is required. Here we review the incidence of DCIS, the perception of risk for developing invasive breast cancer, the current treatment options and the known molecular aspects of progression. Further research is needed to gain new insights for improved diagnosis and management of DCIS, and this is integrated in the PRECISION (PREvent ductal Carcinoma In Situ Invasive Overtreatment Now) initiative. This international effort will seek to determine which DCISs require treatment and prevent the consequences of overtreatment on the lives of many women affected by DCIS.

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Role of postoperative radiotherapy in reducing ipsilateral recurrence in DCIS: an observational study of 1048 cases

Cited by 13 publications

References 28 publications

Ductal Carcinoma in Situ: A French National Survey. Analysis of 2125 Patients

Ductal Carcinoma in Situ: A French National Survey. Analysis of 2125 Patients

Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases

Ductal carcinoma in situ: to treat or not to treat, that is the question

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