TY - JOUR
T1 - Ductal carcinoma in situ of the breast
T2 - Evaluating the role of radiation therapy in the management and attempts to identify low-risk patients
AU - Shah, Chirag
AU - Vicini, Frank A.
AU - Berry, Sameer
AU - Julian, Thomas B.
AU - Wilkinson, John Ben
AU - Shaitelman, Simona F.
AU - Khan, Atif
AU - Finkelstein, Steven E.
AU - Goldstein, Neal
N1 - Publisher Copyright:
Copyright © 2013 Wolters Kluwer Health, Inc.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Ductal carcinoma in situ of the breast has rapidly increased in incidence over the past several decades secondary to an increased use of screening mammography. Local treatment options for women diagnosed with ductal carcinoma in situ include mastectomy or breastconserving therapy. Although several randomized trials have confirmed a >50% reduction in the risk of local recurrence with the administration of radiation therapy (RT) compared with breast-conserving surgery alone, controversy persists regarding whether or not RT is needed in selected "low-risk" patients. Over the past two decades, two prospective single-arm studies and one randomized trial have been performed and confirm that the omission of RT after surgery is associated with higher rates of local recurrence even after selecting patients with optimal clinical and pathologic features. Importantly, these trials have failed to consistently and reproducibly identify a low-risk cohort of patients (based on clinical and pathologic features) that does not benefit from RT. As a result, adjuvant RT is still advocated in the majority of patients, even in low-risk cases. Future research is moving beyond traditional clinical and pathologic risk factors and instead focusing on approaches such as multigene assays and biomarkers with the hopes of identifying truly low-risk patients who may not require RT. However, recent studies confirm that even low-risk patients identified from multigene assays have higher rates of local recurrence with local excision alone than would be expected with the addition of RT.
AB - Ductal carcinoma in situ of the breast has rapidly increased in incidence over the past several decades secondary to an increased use of screening mammography. Local treatment options for women diagnosed with ductal carcinoma in situ include mastectomy or breastconserving therapy. Although several randomized trials have confirmed a >50% reduction in the risk of local recurrence with the administration of radiation therapy (RT) compared with breast-conserving surgery alone, controversy persists regarding whether or not RT is needed in selected "low-risk" patients. Over the past two decades, two prospective single-arm studies and one randomized trial have been performed and confirm that the omission of RT after surgery is associated with higher rates of local recurrence even after selecting patients with optimal clinical and pathologic features. Importantly, these trials have failed to consistently and reproducibly identify a low-risk cohort of patients (based on clinical and pathologic features) that does not benefit from RT. As a result, adjuvant RT is still advocated in the majority of patients, even in low-risk cases. Future research is moving beyond traditional clinical and pathologic risk factors and instead focusing on approaches such as multigene assays and biomarkers with the hopes of identifying truly low-risk patients who may not require RT. However, recent studies confirm that even low-risk patients identified from multigene assays have higher rates of local recurrence with local excision alone than would be expected with the addition of RT.
KW - Breast cancer
KW - Breast-conserving surgery
KW - DCIS
KW - Radiation therapy
UR - http://www.scopus.com/inward/record.url?scp=84941880159&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84941880159&partnerID=8YFLogxK
U2 - 10.1097/COC.0000000000000102
DO - 10.1097/COC.0000000000000102
M3 - Review article
C2 - 25036472
AN - SCOPUS:84941880159
SN - 0277-3732
VL - 38
SP - 526
EP - 533
JO - American Journal of Clinical Oncology: Cancer Clinical Trials
JF - American Journal of Clinical Oncology: Cancer Clinical Trials
IS - 5
ER -