Is excision alone adequate for low-risk DCIS of the breast treated with breast conserving therapy

Journal of Radiation Oncology - Tập 3 - Trang 21-28 - 2013
Chirag Shah1, Thomas B. Julian2, J. Ben Wilkinson3, Simona F. Shaitelman4, Atif Khan5, Steven Finkelstein6, Frank A. Vicini7
1Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, USA
2Department of Surgical Oncology, Drexel University College/Allegheny General Hospital, Pittsburgh, USA
3Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, USA
4University of Texas M. D. Anderson Cancer Center, Houston, USA
5Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, USA
621st Century Oncology, Scottsdale, USA
7Michigan Healthcare Professionals, 21st Century Oncology, Farmington Hills, USA

Tóm tắt

Ductal carcinoma in situ (DCIS) represents a quarter of newly diagnosed breast neoplasms, with the majority of cases detected on routine screening mammography in asymptomatic women. Currently, most women with newly diagnosed DCIS are eligible for breast conserving therapy (BCT); however, significant controversy exists regarding whether or not to add radiation treatment (RT) after surgical excision in low-risk patients. While four older prospective randomized clinical trials have shown that the addition of RT after lumpectomy reduces the risk of ipsilateral breast tumor recurrence (IBTR) by approximately 50 %, recent studies have continued to attempt to identify a subset of patients with favorable risk DCIS who are at a sufficiently low-risk of IBTR that omitting RT might be reasonable. While a number of smaller studies have shown promising results, recent prospective data have consistently affirmed the increased risk of IBTR with the omission of RT, with no subset of patients consistently identified that can be safely observed without RT. While radiation after lumpectomy remains the “standard of care,” even in these low-risk patients, future directions include improvements in genetic assays to better identify low-risk patients and new RT techniques and schedules that can potentially reduce the duration of therapy and toxicity while improving quality of life for patients. Based on the data available, we continue to recommend radiation therapy for low-risk patients with DCIS as no discernible subset has been identified that does not benefit from radiation therapy.

Tài liệu tham khảo

DeSantis C, Siegel R, Bandi P et al (2011) Breast cancer statistics. CA Cancer J Clin 61:409–418

Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241

Solin LJ, Fourquet A, Vicini FA et al (2005) Long term outcome after breast-conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast. Cancer 103:1137–1146

Wu X, Chen VW, Ruiz B et al (2003) Patterns of treatment for ductal carcinoma in situ of the breast in Louisiana, 1988–1999. J La State Med Soc 155:206–213

National Comprehensive Cancer Network. Guidelines: breast cancer. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#breast. Accessed August 30, 2012.

Punglia RS, Weeks JC, Neville BA et al (2008) Effect of distance to radiation treatment facility on use radiation therapy after mastectomy in elderly women. Int J Radiat Oncol Biol Phys 66:56–63

Shroen AT, Brenin DR, Kelly MD et al (2005) Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer. J Clin Oncl 23:7074–7080

Dean CT, Jubelirer SJ, Plants BA et al (2009) Use of radiation after breast conserving surgery (BCS) for DCIS and early invasive breast cancer at Charleston Area Medical Center (CAMC). A study of compliance with National Comprehensive Center Network (NCCN) guidelines. W V Med J 105:39

Fisher B, Land S, Mamounas E et al (2001) Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the National Surgical Adjuvant Breast and Bowel Project experience. Semin Oncol 28:400–418

Bijker N, Meijnen P, Peterse JL et al (2006) Breast-conserving treatment with or without radiotherapy in ductal carcinoma in-situ: ten-Year results of the 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. J Clin Oncol 24:3381–3387

Holmberg L, Garmo H, Granstrand B et al (2008) Absolute risk reduction for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast. J Clin Oncol 26:1247–1252

Cuzick J, Sestak I, Pinder SE et al (2011) Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol 12:21–29

Wapnir IL, Dignam JJ, Fisher B et al (2011) Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 103:478–488

Clarke M, Collins R, Darby S et al (2005) Effects of radiotherapy and differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106

Correa C, McGale P, Taylor C et al (2010) Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr 2010:162–177

Julian TV, Land SR, Wang Y, et al. Is boost therapy necessary in the treatment of DCIS? American Society of Clinical Oncology: Breast Symposium. Abstract 146. San Francisco, California, September 7–8, 2007.

Rudloff U, Brogi E, Reiner AS et al (2010) The influence of margin width and volume of disease near margin on benefit of radiation therapy for women with DCIS treated with breast-conserving therapy. Ann Surg 251:583–591

Dick AW, Sorbero MS, Ahrendt GM et al (2011) Comparative effectiveness of ductal carcinoma in situ management and the roles of margins and surgeons. J Natl Cancer Inst 103:92–104

Morrow M, Katz SJ (2012) Margins in ductal carcinoma in situ: is bigger really better? J Natl Cancer Inst 104:494–495

Fisher B, Dignam J, Wolmark N et al (1999) Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet 353:1993–2000

Hetelekidis S, Collins L, Silver B et al (1999) Predictors of local recurrence following excision alone for ductal carcinoma in situ. Cancer 85:427–431

Silverstein MJ, Lagios MD, Groshen S et al (1999) The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 340:1455–1461

Macdonald HR, Silverstein MJ, Lee LA et al (2006) Margin width as the sole determinant of local recurrence after breast conservation in patients with ductal carcinoma in situ of the breast. Am J Surg 192:420–422

Rampaul R, Valasiadou P, Pinder S et al (2001) Wide local excision with 10 mm clearance without radiotherapy for DCIS. Eur J Surg Oncol 27:788

van der Velden AP S, van Vugt R, Van Dijck JA et al (2007) Local recurrences after different treatment strategies for ductal carcinoma in situ of the breast: a population-based study in the East Netherlands. Int J Radiat Oncol Biol Phys 69:703–710

Cutuli B, Cohen-Solal-le Nir C, de Lafontan B et al (2002) Breast-conserving therapy for ductal carcinoma in situ of the breast: the French Cancer Centers’ experience. Int J Radiat Oncol Biol Phys 53:868–879

Hughes LL, Wang M, Page DL et al (2009) Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol 27:5319–5324

Solin L, Gray R, Baehner FL, et al. A quantitative multigene RT-PCR assay for predicting recurrence risk after surgical excision alone without irradiation for ductal carcinoma in situ (DCIS): a prospective validation study of the DCIS score from ECOG E5194. 34th Annual San Antonio Breast Cancer Symposium. Abstract S4-6. San Antonio, Texas, December 6–10, 2011.

Wong JS, Kaelin CM, Troyan SL et al (2006) Prospective study of wide excision alone for ductal carcinoma in situ of the breast. J Clin Oncol 24:1031–1036

McCormick B (2012) RTOG 9804: A prospective randomized trial for “good risk” ductal carcinoma in situ (DCIS), comparing radiation (RT) to observation (OBS). J Clin Oncol 30(s):1004

Hughes KS, Schnaper LA, Cirrincione C et al (2010) Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer. J Clin Oncol 28(s):507

Fyles AW, McCready DR, Manchul LA et al (2004) Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med 35:963–970

Potter R, Gnant M, Kwasny W et al (2007) Lumpectomy plus tamoxifen or anastrozole with or without whole breast irradiation in women with favorable early breast cancer. Int J Radiat Oncol Biol Phys 68:334–340

Silverstein MJ, Lagios MD (2010) Choosing treatment for patients with ductal carcinoma in sit: fine tuning the University of Southern California/Van Nuys Prognostic Index. J Natl Cancer Inst Monogr 41:193–196

Silverstein MJ (2003) An argument against routine use of radiotherapy for ductal carcinoma in situ. Oncology (Williston Park) 17:1511–1533

McAusland SG, Hepel JT, Chong FK et al (2007) An attempt to independently verify the utility of the Van Nuys Prognostic Index for ductal carcinoma in situ. Cancer 110:2648–2653

Di Saverio S, Catena F, Santini D et al (2008) 259 patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up. Breast Cancer Res Treat 109:405–416

Rudloff U, Jacks LM, Goldberg JI et al (2010) Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol 28:3762–3769

Yi M, Meric-Bernstam F, Kuerer HM et al (2012) Evaluation of a breast cancer nomogram for predicting risk of ipsilateral breast tumor recurrence in patients with ductal carcinoma in situ after local excision. J Clin Oncol 30:600–607

Knauer M, Mook S, Rutgers JT et al (2010) The predictive value of the 70-gene signature for adjuvant chemotherapy in early breast cancer. Breast Cancer Res Treat 120:655–661

Mook S, Schmidt MK, Weigelt B et al (2010) The 70-gene prognosis signature predicts early metastasis in breast cancer patients between 55 and 70 years of age. Ann Oncol 21:717–722

Mamounas EP, Tang G, Fisher B et al (2010) Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor-positive breast cancer: results from the NSABP B-14 and NSABP B-20. J Clin Oncol 28:1677–1683

Tang G, Cuzick J, Constantino JP et al (2011) Risk of recurrence and chemotherapy benefit for patients with node-negative, estrogen receptor-positive breast cancer: recurrence score alone and integrated with pathologic and clinical factors. J Clin Oncol 29:4365–4372

Badve SS, Gray RJ, Baehner FL et al (2012) Correlation between the DCIS score and traditional clinicopathologic features in the prospectively designed E5194 clinical validation study. J Clin Oncol 30:1005

Cancer Trials Support Unit: NSABP B-43. https://www.ctsu.org/readfile.aspx?sectionid=31&fname=protocols/nsabp/nsabp-b-43/NSABP_B43_PFS_010612.pdf. Accessed November 5, 2012.

Whelan TJ, Pignol JP, Levine MN et al (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362:513–520

Williamson D, Dinniwell R, Fung S et al (2010) Local control with conventional and hypofractionated adjuvant radiotherapy after breast-conserving surgery for ductal carcinoma in-situ. Radiother Oncol 95:317–320

Smith BD, Bentzen SM, Correa CR et al (2011) Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guidelines. Int J Radiat Oncol Biol Phys 81:59–68

Polgar C, Fodor J, Major T et al (2007) Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma — 5-year results of a randomized trial. Int J Radiat Oncol Biol Phys 69:694–702

Vicini F, Shah C, Wilkinson JB, et al (2013) Should ductal carcinoma in situ be removed from the ASTRO cautionary group for off-protocol use of accelerated partial breast irradiation (APBI)? A pooled analysis of outcomes for 300 patients with DCIS treated with APBI. Ann Surg Oncol 20:1275–81

Goyal S, Vicini F, Beitsch PD et al (2011) Ductal carcinoma in situ treated with breast-conserving surgery with accelerated partial breast irradiation: comparison of the Mammosite registry trial with intergroup study E5194. Cancer 117:1149–1155

Vaidya JS, et al. (2012) Targeted intraoperative radiotherapy for early breast cancer: TARGIT-A trial-updated analysis of local recurrence and first analysis of survival. SABCS; Abstract S4-2.

Orecchia R (2012) Eliot trials in Milan: results. Radiother Oncol 103:S4

Bartelink H, Horiot JC, Poortmans PM et al (2007) 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. J Clin Oncol 25:3259–3265

Romestaing P, Lehinque Y, Carrie C et al (1997) Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon. France J Clin Oncol 15:963–968

Julian TB, Land SR, Wang Y, et al. Is boost therapy necessary in the treatment of DCIS? http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=52&abstractID=40258. Accessed December 11, 2012.

Wong P, Lambert C, Agnihotram RV et al (2012) Ductal carcinoma in situ — the influence of the radiotherapy boost on local control. Int J Radiat Oncol Biol Phys 82:e153–e158

Omlin A, Amichetti M, Azria D et al (2006) Boost radiotherapy in young women with ductal carcinoma in situ: a multicentre, retrospective study of the Rare Cancer Network. Lancet Oncol 7:652–656

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Journal of Radiation Oncology

Tập 3

21-28

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