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Radiotherapy boost may reduce ipsilateral breast tumor recurrence in women with DCIS
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Radiotherapy boost after whole-breast radiotherapy led to lower rates of ipsilateral breast tumor recurrence in patients with ductal carcinoma in situ, according to results of a retrospective study.
“This study suggests that a radiotherapy boost for ductal carcinoma in situ [DCIS] after whole-breast radiotherapy is associated with a small, but statistically significant, benefit in decreasing long-term ipsilateral breast tumor recurrence in magnitude similar to that experienced with invasive cancer boost,” Meena S. Moran, MD, professor of therapeutic radiology and assistant clinical professor of nursing at Yale Cancer Center, and colleagues wrote.
Moran and colleagues analyzed pooled, deidentified patient-level data from 4,131 patients (median age, 56.1 years; range, 24-88) with newly diagnosed DCIS from 10 academic institutions in the United States, Canada and France. Of these patients, 2,661 received a radiotherapy boost (median boost dose, 14 Gy) and 1,470 did not. Patients with positive margins, unknown ER status and comedo necrosis were more likely to receive a radiotherapy boost.
Median follow-up was 9 years.
Ipsilateral breast tumor recurrence events occurred in 253 patients (6.1%). Of these, 118 (46.6%) were invasive.
Rates of ipsilateral breast tumor RFS were 96.8% at 5 years, 93.6% at 10 years and 90.4% at 15 years.
Patients who received a radiotherapy boost demonstrated higher rates of ipsilateral breast tumor RFS than patients who did not receive a boost at 5 years (97.1% vs. 96.3%), 10 years (94.1% vs. 92.5%) and 15 years (91.6% vs. 88%).
Univariate analysis showed radiotherapy boost was associated with lower ipsilateral breast tumor recurrence (HR = 0.73; 95% CI, 0.57-0.94).
Multivariate analysis showed the boost remained independently associated with reduced ipsilateral breast tumor recurrence — regardless of age and tamoxifen use — compared with patients who did not receive a boost (HR = 0.68; 95% CI, 0.5-0.91).
“Ultimately, DCIS treatment decisions are complex and need to be tailored to the patient’s age, clinicopathologic features, tumor biology, individualized preferences and anticipated longevity,” the researchers wrote. – by Melinda Stevens
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Kathryn Evers
The treatment of ductal carcinoma in situ (DCIS) has become controversial, with debate over whether this is a “real” cancer or merely a high-risk lesion. Lumpectomy followed by radiation therapy has been standard treatment in patients who desire breast conservation, with the use of a boost to the lumpectomy bed used in some centers and patients and not in others. As approximately half of recurrences following treatment are invasive carcinomas, decreasing the recurrence rate is an important goal. That this benefit appears to be greater in younger patients with higher-grade disease underscores the fact that DCIS is not a single disease.
The suggestion that the overall ipsilateral breast recurrence rate in patients with DCIS is decreased with the use of a boost fills a void in our knowledge. Although this is a retrospective study and a definitive answer awaits the results of ongoing prospective trials, this is important information and may prove to be of great benefit to patients with DCIS.
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