Study Shows Strong Evidence Supporting Radiation Boost to Tumor Bed in Ductal Carcinoma in Situ

Excerpt:

“A radiation boost to the local tumor bed following treatment with breast-conserving therapy (ie, local excision followed by whole-breast radiation therapy) improves local control for patients with ductal carcinoma in situ, according to a study of pooled data from 10 academic centers, presented at the 58th Annual Meeting of the American Society of Radiation Oncology (ASTRO). The magnitude of improvement is similar to that seen for a radiation boost in invasive breast cancer.”

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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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Guidelines Establish Minimum Negative Margins in DCIS

Excerpt:

“Three medical organizations including the American Society of Clinical Oncology (ASCO) have issued a guideline on margins in breast conserving surgery for patients with ductal carcinoma in situ (DCIS). The new recommendations are published online ahead of print in the Journal of Clinical Oncology.

“The panel of experts from ASCO, the Society of Surgical Oncology (SSO), and the American Society for Radiation Oncology (ASTRO) recommend the use of 2-mm margins as a standard in breast conserving surgery for DCIS treated with whole-breast irradiation. Margins of 2 mm are ‘associated with low rates of ipsilateral breast tumor recurrence and has the potential to decrease re-excision rates, improve cosmetic outcome, and decrease health care costs,’ wrote Monica Morrow, MD, of the department of surgery at the Memorial Sloan Kettering Cancer Center in New York, and coauthors. ‘Clinical judgment should be used in determining the need for further surgery in patients with negative margins less than 2 mm. Margins more widely clear than 2 mm do not further reduce the rates of recurrence of cancer in the breast and their routine use is not supported by evidence.’ ”

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Testing After DCIS Needle Biopsies: $35 Million Boondoggle

Excerpt:

“In the United States, a common practice in the management of ductal carcinoma in situ (DCIS) costs an estimated $35 million a year, but is unnecessary, according to a new study.

“Automatically testing core needle biopsy DCIS specimens for hormone receptors is wasteful for a variety of reasons and should be abandoned, say the researchers, led by Pedram Argani, MD, a surgical pathologist at Johns Hopkins Hospital in Baltimore.

“The study was published online June 13 in the American Journal of Surgical Pathology.

“Core biopsy testing is not needed because the results do not influence the next step in standard therapy — surgical excision. Testing can be done later, if needed, on the larger excised specimen, Dr Argani and his colleagues explain.”

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Delays in Radiation Therapy Increase Chance of Breast Tumor Development in Women Treated for Ductal Carcinoma in Situ

Excerpt:

“Women who underwent treatment for ductal carcinoma in situ (DCIS), a noninvasive breast abnormality, were at higher risk of developing malignant breast tumors if they did not receive timely radiation therapy as part of their treatment, according to a study presented here at the AACR Annual Meeting 2016, April 16-20.

“DCIS is the most common premalignant breast lesion, with over 60,000 women diagnosed each year. Not all DCIS will develop into invasive cancer, but because it is difficult to predict which cases will become cancerous, most women diagnosed with DCIS undergo treatment for it.

“ ‘According to the National Comprehensive Cancer Network guidelines, primary treatment options for DCIS include breast-conserving surgery plus radiation, total mastectomy, and breast-conserving surgery alone,’ said the study’s lead author, Ying Liu, MD, PhD, instructor of surgery at Washington University School of Medicine and a research member at Siteman Cancer Center in St. Louis, Missouri. ‘This study shows that it is important for women to understand the benefits of timely receipt of radiation therapy after breast-conserving surgery.’ ”

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Does Radiation Therapy Improve Survival for Women With Ductal Carcinoma in Situ?

“Approximately 60,000 patients in the United States will receive a diagnosis of ductal carcinoma in situ (DCIS) in 2016. DCIS is not an invasive form of cancer and the 10-year survival rate for women with DCIS is greater than 98 percent. However, incidence of DCIS has increased dramatically over the last three decades, and being able to determine which women are among the small percentage at higher risk of breast cancer recurrence and mortality could help clinicians and patients tailor treatment to neither over treat nor under treat the disease. Investigators from Brigham and Women’s Hospital (BWH) and the Dana-Farber Cancer Institute have found that a set of easily measurable risk factors can predict the magnitude of survival benefit offered by radiation therapy following breast cancer surgery. Their results appear online in the Journal of Clinical Oncology on Feb. 1.”


Two Drugs Equal For Early Breast Cancer

“Postmenopausal women who have an early, noninvasive form of breast cancer had similar recurrence rates of disease whether they took the drug tamoxifen or the aromatase inhibitor anastrozole after surgery, new research shows.

“However, the side effects of the two medications differed greatly, said study author Jack Cuzick, director of the Wolfson Institute of Preventive Medicine at Queen Mary University of London, England.

“His team looked at nearly 3,000 women, all past menopause, who had hormone-receptor positive ductal carcinoma in situ (DCIS) breast cancer and underwent surgery to excise it. With DCIS, the cells that line the milk ducts have changed but not spread into the surrounding breast tissue.”


Stage 0 Breast Cancer: When Should You Wait and See?

“In cancer, as in other areas of medicine, early detection can save lives. But the screening tests used to find early tumors also detect disease that would never cause problems – disease you’ll die with but not from. Managing those cases means giving potentially harmful treatment to patients who won’t benefit.

“DCIS, or ductal carcinoma in situ, is the poster child of this dilemma. Before routine mammograms, only about 1 percent of U.S. breast cancer cases were DCIS. Now nearly 65,000 women a year – about 22 percent of those with breast cancer – are diagnosed with DCIS.

“DCIS, also known as Stage 0 breast cancer, is not life-threatening, and not all cases will progress to invasive cancer. But because there is no reliable way to determine which ones will, nearly all DCIS is surgically removed with a lumpectomy or mastectomy (and sometimes the healthy breast is removed prophylactically). Most DCIS patients also are offered radiation and drugs.”


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.”