Radiotherapy reduces local recurrences after breast-conserving surgery for ductal carcinoma in situ (DCIS), according to a report in the August 2nd online publication of Radiation Oncology. by Will Boggs, MD


Radiotherapy reduces local recurrences after breast-conserving surgery for ductal carcinoma in situ (DCIS), according to a report in the August 2nd online publication of Radiation Oncology.

"Our data demonstrate a reduction of the risk of a local in-breast recurrence (invasive and DCIS) with radiotherapy, although there was no survival benefit compared to excision alone," Dr. Gustavo A. Viani from Faculdade de Medicina de Marilia, Sao Paulo, Brazil told Reuters Health.

Dr. Viani and colleagues used results from recent randomized trials to evaluate the impact of adjuvant radiotherapy on women with DCIS. Specifically, they examined rates of in situ recurrence, invasive breast recurrence, distant metastasis, and mortality. Another goal was to identify patients who do not need adjuvant radiotherapy.

In the NSABPB-17 trial, the cumulative incidence of recurrences after 12 years of follow-up was 15.7 per cent in the lumpectomy-plus-radiation group, compared with 31.7 per cent in the lumpectomy-alone group, the authors report, but the overall survival did not differ between the two groups.

After 4.25 years of follow-up in the EORTC10853 trial, the local recurrence rate was lower in the lumpectomy-plus-radiation arm (11 per cent) than in the lumpectomy-only arm (17 per cent). The difference favoring lumpectomy-plus-radiation persisted at the ten-year follow-up.

Similar results were obtained in the UKCCCR study and in the SWE DCIS study, the investigators say.

In the combined analysis, the local ipsilateral recurrence rate was 60 per cent lower in the radiation therapy groups, but there was no difference in overall mortality.

The risk of contralateral recurrence was 1.53-fold higher in radiotherapy patients, the researchers note, but there was no difference between groups in the metastasis rates.

"Based on our results, I recommend radiotherapy for all women (without contraindications for radiotherapy) younger than 50 years old with DCIS, independently from the tumor grade and hormonal receptor status," Dr. Viani said. "On the other hand, with patients older than 70 years old who have DCIS expressing hormonal receptors with low grade nuclear and surgical margins and without residual tumor (clear), I discuss the benefits of radiotherapy considering the gain in the local control versus the life expectancy using tamoxifen alone."

Patients in the intermediate subgroup (age 50-70 years old, with or without low grade DCIS and with or without hormonal receptor) make up a heterogeneous group, Dr. Viani noted. "As it has not been possible to identify a subgroup of patients who do not get any benefit from adjuvant radiotherapy, we prefer to recommend radiotherapy," weighing the benefits of the local control compared to the side effects, he added.

"Ongoing trials by both European and the United States cooperative groups are addressing the issue of benefit from radiotherapy," Dr. Viani explained. "The results of these studies should provide information on the efficacy of lumpectomy alone with good-risk DCIS and may allow the development of criteria to identify subgroups of patients who do not require adjuvant radiation therapy."


Source: Reuters

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