RTOG 9804: A Prospective Randomized Trial for Good-Risk Ductal Carcinoma In Situ Comparing Radiotherapy With Observation

McCormick, Beryl; Winter, Kathryn; Hudis, Clifford A.; Kuerer, Henry Mark; Rakovitch, Eileen; Smith, Barbara L.; Sneige, Nour; Moughan, Jennifer; Shah, Amit Kumar; Germain, Isabelle; Hartford, Alan C.; Rashtian, Afshin; Walker, Eleanor M.; Yuen, Albert; Strom, Eric A.; Wilcox, Jeannette L.; Vallow, Laura A.; Small, William; Pu, Anthony T.; Kerlin, K.; White, Julia

doi:10.1200/jco.2014.57.9029

Cited by 342 publications

(282 citation statements)

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“…11 With a median follow-up of 7.2 years, risk of IBTR was 6.7% risk in the observation arm compared with 0.9% in the WBI arm. Similar results were noted in the initial publication of the Eastern Cooperative Oncology Group (ECOG) 5194 trial among patients meeting similar criteria, with observation yielding a 6.1% risk of IBTR at 6.7 years' median follow-up and 14.4% risk at 12 years.…”

Section: Pure Dcismentioning

confidence: 88%

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

Correa

Harris

Leonardi

et al. 2017

Practical Radiation Oncology

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Section: Pure Dcismentioning

confidence: 88%

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

Correa

Harris

Leonardi

et al. 2017

Practical Radiation Oncology

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507

342

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“…Randomized trials have confirmed that recurrence rates with BCS alone are higher than those with BCS plus radiation treatment, even in patients selected for favorable clinical and pathologic features (62)(63)(64). In addition, there is a small survival advantage of radiation in patients with invasive breast cancer.…”

Section: Radiationmentioning

confidence: 99%

Clinical Diagnosis and Management of Breast Cancer

et al. 2016

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The diagnosis and management of breast cancer are undergoing a paradigm shift from a one-size-fits-all approach to an era of personalized medicine. Sophisticated diagnostics, including molecular imaging and genomic expression profiles, enable improved tumor characterization. These diagnostics, combined with newer surgical techniques and radiation therapies, result in a collaborative multidisciplinary approach to minimizing recurrence and reducing treatment-associated morbidity. This article reviews the diagnosis and treatment of breast cancer, including screening, staging, and multidisciplinary management. In this article, we address current approaches to breast cancer diagnosis and management. These approaches include screening recommendations; diagnostic imaging and pathologic assessment to determine the extent of disease; surgery and radiation treatment; and an array of systemic options, such as chemotherapy, endocrine therapy, and targeted agents (Fig. 1). We also consider the potential contribution of functional imaging to a new era of personalized, tumor-specific treatment. BREAST CANCER DIAGNOSIS ScreeningBreast cancer is generally diagnosed through either screening or a symptom (e.g., pain or a palpable mass) that prompts a diagnostic exam. Screening of healthy women is associated with the detection of tumors that are smaller, have lower odds of metastasis, are more amenable to breast-conserving and limited axillary surgery, and are less likely to require chemotherapy (1). This scenario translates to reduced treatment-related morbidity and improved survival.The only screening modality proven to reduce breast cancerspecific mortality is mammography (2). Screening mammography leads to a 19% overall reduction in breast cancer mortality (3), with less benefit for women in their 40s (15%) and more benefit for women in their 60s (32%). As a result, screening mammography is recommended by the American Cancer Society beginning at age 45, or sooner depending on individual preference. The potential negative aspects of screening mammography are falsepositive examinations, radiation exposure, pain, anxiety, and other negative psychologic effects. Mammography has a 61% chance of a false-positive result over a 10-y period for women commencing screening between the ages of 40 y and 50 y. The risk of a falsepositive examination decreases with older age (3). The US Preventative Task Force cited a 15% breast cancer-related mortality reduction for women who were 39-49 y old and a mortality-related benefit from screening between ages 39 and 69. However, the task force released a controversial report recommending only biennial screening mammography for women who were 50-74 y old, excluding younger women to a large extent because of the high rate of false-positive results (4). Mammography for women in the 39-to 49-y-old age group was recommended if indicated after the use of a risk-based model of breast cancer screening, such as the models developed by the Population-Based Research Optimizing Screening Through Personalized Re...

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“…In determining what is an acceptable rate of in-breast recurrence, we might look to the European Society of Breast Cancer Specialists (EUSOMA) guidelines [5], which suggest that an acceptable rate of in-breast recurrence is 1-2 % per year, or we could look at the rate of contralateral breast cancer as a possible benchmark. McCormick et al [6] found that lowto-intermediate-grade DCIS treated with tamoxifen but without radiation had a 7-year in-breast recurrence risk of 6.7 % (95 % confidence interval 3.4-10), not dissimilar to the contralateral breast cancer incidence of 4.8 % (95 % confidence interval 2.0-7.7) and well below the 1-2 % per annum suggested by EUSOMA. If a local therapy (surgery plus/minus tamoxifen) produces a rate of in-breast recurrence that is less than 1-2 % per year, and if that rate is similar to the baseline rate of breast cancer occurrence in the untreated breast, is that not sufficient evidence to recommend that approach?…”

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confidence: 91%

DCIS does not need treatment… really?

Hughes

2015

Breast Cancer Res Treat

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RTOG 9804: A Prospective Randomized Trial for Good-Risk Ductal Carcinoma In Situ Comparing Radiotherapy With Observation

Abstract: In this good-risk subset of patients with DCIS, with a median follow-up of 7 years, the LF rate was low with observation but was decreased significantly with the addition of RT. Longer follow-up is planned because the timeline for LF in this setting seems protracted.

Cited by 342 publications

References 25 publications

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

Clinical Diagnosis and Management of Breast Cancer

DCIS does not need treatment… really?

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