Benefit of Radiation Boost in DCIS Validated

Excerpt:

“A radiation boost to the tumor bed led to a small but statistically significant reduction in breast cancer recurrence after breast-conserving therapy for ductal carcinoma in situ (DCIS), a randomized study showed.

“Women who received the radiation boost had a 15-year freedom from ipsilateral recurrence of 91.6% compared with 88.0% for patients who had lumpectomy and adjuvant irradiation but not boost to the tumor bed. The additional protection afforded by the radiation boost encompassed both DCIS and invasive recurrence.”

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Recommendation to Omit Radiation Therapy After Lumpectomy Is Not Frequently Implemented

“Nearly two thirds of U.S. women age 70 or older with stage I breast cancer who undergo lumpectomy and are eligible to safely omit subsequent radiation therapy (RT) according to national cancer guidelines still receive this treatment, according to new study results. The researchers looked at more than 205,000 cases of breast cancer nationwide, and their study is published as an ‘article in press’ on the Journal of the American College of Surgeons website in advance of print publication.

“After a lumpectomy, also called a breast-sparing or breast-conserving operation, radiation usually is given to the breast to reduce the chance of the cancer returning. However, treatment recommendations changed in 2004 for a select group of elderly breast cancer patients after research found that postoperative RT did not significantly prolong their survival over five years compared with women who received no RT.”


Removing More Breast Tissue during Surgery Reduces Costs

“A 10-minute procedure to remove a little more tissue during a partial mastectomy could spare thousands of breast cancer patients a second surgery but and also cut costs by as much as $750 per patient, according to a Yale Cancer Center study.

“The findings are scheduled for presentation Dec. 10 at the 2015 Annual San Antonio Breast Cancer Symposium.

“Nearly 300,000 women in the United States are diagnosed with breast cancer each year; more than half undergo breast-conserving surgery with a partial mastectomy to remove the disease. About a third of patients who undergo this procedure have ‘positive margins,’ or cancer cells found at the edge of the removed tissue, and will require a second surgery to ensure that no cancer remains. A Yale study, published online in May in the New England Journal of Medicine, demonstrated that removing more tissue all the way around the tumor site during the initial surgery — known as cavity shave margins (CSM) — could cut the need for a second surgery in half.”


MRI Tied to More Aggressive Breast Cancer Treatment

“The use of preoperative magnetic resonance imaging (pMRI) in women with newly diagnosed breast cancer has increased by eightfold during the past 10 years in Canada’s most populous province and is associated with significant increases in adverse downstream consequences, including more mastectomies, a population-based study indicates.

“The research was published online September 24 in JAMA Oncology.

“Angel Arnaout, MD, University of Ottawa, in Ontario, and colleagues found that 14.8% of a cohort of 53,015 women treated with newly diagnosed breast cancer between 2003 and 2012 had undergone pMRI in the province of Ontario.

“A total of 65% of the cohort underwent breast-conserving surgery.”


DCIS Surgery Outcomes Have Improved over Time

“Women with ductal carcinoma in situ (DCIS) treated with breast conserving surgery at Memorial Sloan Kettering Cancer Center in New York City from 1999 to 2010 had a 40% lower risk of cancer recurrence than those treated at the same institution between 1978 and 1998, a retrospective review of the prospectively maintained database has revealed.

“Five-year recurrence rates fell from 13.6% to 6.6% over these two periods and were limited to women who did not receive radiation therapy, Kimberly J. Van Zee, MD, MS, of Memorial Sloan Kettering Cancer Center reported at the American Society of Clinical Oncology (ASCO) Breast Cancer Symposium, Sept. 25-27.

” ‘Since radiation is given only to reduce local recurrence rates and has never been shown to improve survival, a woman treated currently with breast conservation without radiation can expect about a 40% lower recurrence rate than in the earlier decades,’ said Van Zee.”


DCIS Predicts Risk of Local Recurrence

“Another study has confirmed that the DCIS Score independently predicts the risk of local recurrence in a population of patients with ductal carcinoma in situ (DCIS) who were treated with breast-conserving surgery alone (BCS), analysis of the Ontario CDIS cohort indicates.

“In a cohort of 718 patients treated with BCS alone, there were 100 local recurrences (LR), 44 of them being DCIS local recurrences and 57 being invasive (one case developed an invasive local recurrence after a DCIS local recurrence).

“The overall 10-year rate of local recurrence was 19.2%

“Approximately two-thirds of the women in the study had a low-risk DCIS Score; 16.6% had an intermediate risk DCIS score and 21.2% had a high-risk DCIS score.”


(video) Dr. Chagpar on the SHAVE Trial for Breast Cancer

“Anees B. Chagpar, MD, MA, MPH, MBA, FRCS(C), FACS, associate professor of surgery (oncology), director, The Breast Center at Smilow Cancer Hospital at Yale-New Haven, assistant director, Global Oncology, Yale Comprehensive Cancer Center, discusses initial results of the SHAVE trial for patients with breast cancer.

“The majority of women annually diagnosed with early-stage breast cancer will opt for breast conserving surgery. The objective of this procedure, Chagpar explains, is to ensure that no cancer touches the edge of the specimen. For patients with positive margins, surgeons often remove more tissue during a second surgery. The SHAVE trial examined the efficacy of greater cavity shaving in the first surgery as opposed to a second.

“The randomized SHAVE trial permitted surgeons to conduct breast conserving surgery as they normally would. Before closing the procedure, in the operating room, surgeons were randomized to either close the surgery or remove more tissue around the cavity. Results showed that more cavity shaving demonstrated a 50% decrease in reexcision rates and positive margin rates. This did not affect complication rates or patients’ perspective on their cosmetic outcomes, Chagpar says.”


Low Axillary Recurrence/Mortality Among Older Women With Node-Negative Breast Cancer Undergoing Breast-Conserving Surgery Without Sentinel Node Biopsy

“In a single institution study reported in JAMA Surgery, Chung et al found a low axillary recurrence rate and low mortality among women with clinical T1–2N0 breast cancer aged ≥ 70 years who underwent breast-conserving surgery without sentinel node biopsy.

“The study involved 140 women treated at Cedars-Sinai Medical Center between January 2000 and December 2011. Patients had a median age of 83 years (range = 70–97 years); 74% had T1 tumors; 27% had grade 1, 44% grade 2, and 29% grade 3 tumors; 86% were estrogen receptor–positive; 73% were progesterone receptor–positive; 92% were HER2-negative; and 65% had ductal histology. Overall, 98% received chemotherapy, 76% radiotherapy, and 59% hormonal therapy…

“The investigators concluded: ‘Our study demonstrated low axillary recurrence and low mortality for patients with clinical T1–2N0 breast cancer who were 70 years of age or older and who underwent breast-conserving surgery without a sentinel node biopsy.’ “


Rates of Breast-Conserving Therapy for Early-Stage Breast Cancer Have Increased, Study Finds

“The number of women in the US undergoing breast-conserving therapy following a diagnosis of early-stage breast cancer has risen during the past 2 decades, according to a new study published in JAMA Surgery, though the authors reveal there are still barriers preventing women from receiving the treatment.

“After skin cancer, breast cancer is the most common cancer among American women, estimated to affect around 1 in 8 at some point in their lives.

“The majority of women diagnosed with breast cancer undergo some form of surgery, particularly if the cancer is diagnosed in the early stages. The surgical options available include mastectomy and breast-conserving therapy (BCT), or lumpectomy.

“While mastectomy involves full or partial removal of the breast tissue, BCT involves only the removal of the part of the breast containing the cancer.

“There are pros and cons with each procedure. With a mastectomy, a woman may lose an entire breast, while women who undergo BCT may be able to retain the majority of their breast tissue – making it a preferable option for many. However, women who have BCT often need to undergo radiation therapy for around 5-6 weeks following the surgery to ensure any remaining cancer cells are destroyed.”