Use of the Twelve-Gene Recurrence Score for Ductal Carcinoma in Situ and Its Influence on Receipt of Adjuvant Radiation and Hormonal Therapy

57 Background: The purpose of this study was to identify the impact of final surgical margin (SM) status, SM width, and re-excision on outcomes in patients with ductal carcinoma in situ (DCIS) undergoing breast conservation therapy (BCT). Methods: The study population consisted of women diagnosed with DCIS undergoing BCT between 1989-2014. All women received adjuvant whole breast radiation plus a boost. The primary endpoint was local control (LC) defined as an ipsilateral breast failure. A negative SM was defined as > 2 mm, close SM was defined as > 0 to < 2 mm, and a positive SM was defined as tumor at the inked SM. Cox proportional hazards model was used to determine predictors of outcomes on multivariate analysis (MVA). Actuarial incidence of LC was estimated using the Kaplan-Meier method. Results: A total of 498 patients were included. The median age was 58 (range 30-91) and the median follow-up was 8.3 years (3 months-27 years). A total of 400 patients had a final negative SM, 87 had a close SM, and 11 had a positive SM. A total of 172 patients received adjuvant hormonal therapy, 265 patients required at least one re-excision. Patients with positive or close SMs were more likely to receive a radiation dose > 60 Gy (p < 0.001) and undergo re-excision (p < 0.01). The 10-year LC rates were not significantly different between patients with a negative (93.5%), close (91.8%), or positive (100%) SM (p = 0.57). There was no difference in 10-year LC rates according to a SM width of 0-1 mm (100%), > 1 to 2 mm (88.5%), or > 2 mm (93.5%) (p = 0.85). On univariate analysis, there was no significant difference in LC when comparing negative versus close or positive (p = 1.0) SMs. There was no difference in LC in patients undergoing re-excision for initial close or positive SMs (p = 0.55). On MVA, after controlling for age, dose, hormonal therapy, comedo subtype, and grade, there were no factors associated with LC. Conclusions: This large single-institution experience demonstrates that risks of local failure remain poorly characterized. Re-excision and whole breast radiation plus boost resulted in excellent LC for women with DCIS. Our data suggests that trials aimed at personalized de-intensified local therapy are warranted.

Download Full-text

Coronary Calcium Scanning in Patients after Adjuvant Radiation for Early Breast Cancer and Ductal Carcinoma In situ

Frontiers in Oncology ◽

10.3389/fonc.2013.00253 ◽

2013 ◽

Vol 3 ◽

Cited By ~ 10

Author(s):

Monique Chang ◽

Jason Suh ◽

Vatsala Kirtani ◽

Andrei Dobrescu ◽

Jonathan Haas ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Coronary Calcium ◽

Adjuvant Radiation

Download Full-text

Survival outcomes after adjuvant radiation in women ≥ 65 years diagnosed with ductal carcinoma in-situ: Analysis of National Cancer Data Base.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.1058 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. 1058-1058

Author(s):

Wenli Gao ◽

Prakash Peddi ◽

Gary Von Burton ◽

Runhua Shi

Keyword(s):

Data Base ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

National Cancer Data Base ◽

In Situ Analysis ◽

Survival Outcomes ◽

Adjuvant Radiation ◽

Cancer Data

Download Full-text

Adherence to Long-Term Surveillance Mammography Among Women With Ductal Carcinoma In Situ Treated With Breast-Conserving Surgery

Journal of Clinical Oncology ◽

10.1200/jco.2008.18.5876 ◽

2009 ◽

Vol 27 (19) ◽

pp. 3211-3216 ◽

Cited By ~ 10

Author(s):

Larissa Nekhlyudov ◽

Laurel A. Habel ◽

Ninah S. Achacoso ◽

Inkyung Jung ◽

Reina Haque ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Conserving Surgery ◽

First Year ◽

Adjuvant Radiation ◽

Obese Women ◽

Surveillance Mammography

Purpose Breast-conserving surgery (BCS) is an effective treatment for ductal carcinoma in situ (DCIS) but women who undergo BCS remain at risk for recurrences. Whether mammographic surveillance after BCS occurs and by whom is not known. Methods We reviewed medical records of women diagnosed with DCIS between 1990 and 2001 and treated with BCS. Using descriptive statistics, generalized estimating, and logistic regression modeling, we examined the rates and predictors of surveillance mammography over a 10-year period after BCS. Results The cohort included 3,037 women observed for a median of 4.8 years (range, 0.5 to 15.7). Of the 2,676 women observed for at least 1 year after BCS, most (79%) had at least one surveillance mammogram during the first year of follow-up; 69% in year 5 and 61% in year 10. Among those observed for 5 years, surveillance mammograms were more likely among women age 60 to 69 years (odds ratio [OR], 1.72; 95% CI, 1.26 to 2.34), users of menopausal hormone therapy at diagnosis (OR, 1.26; 95% CI, 1.01 to 1.57) as well as those treated with adjuvant radiation (OR, 1.28; 95% CI, 1.08 to 1.53) and adjuvant radiation with tamoxifen (OR, 1.61; 95% CI, 1.13 to 2.30). Surveillance mammograms were less likely among obese women (OR, 0.70; 95% CI, 0.56 to 0.86). The findings were similar among women observed for 10 years. Only 34% and 15% of women observed for 5 and 10 years, respectively, had a surveillance mammogram during each year of follow-up. Conclusion Surveillance mammography after BCS among insured women with DCIS often did not occur yearly and declined over time after treatment. Patients and providers must remain vigilant about surveillance after BCS.

Download Full-text

Neoadjuvant hormonal therapy for ductal carcinoma in situ: Trial design and preliminary results

Annals of Surgical Oncology ◽

10.1007/bf02524794 ◽

2004 ◽

Vol 11 (S1) ◽

pp. 37S-43S ◽

Cited By ~ 21

Author(s):

E. Shelley Hwang ◽

Laura Esserman

Keyword(s):

Ductal Carcinoma In Situ ◽

Hormonal Therapy ◽

Carcinoma In Situ ◽

Trial Design ◽

Ductal Carcinoma ◽

Preliminary Results ◽

Neoadjuvant Hormonal Therapy

Download Full-text

Does the Oncotype DCIS score impact treatment decisions?

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.26_suppl.91 ◽

2013 ◽

Vol 31 (26_suppl) ◽

pp. 91-91

Author(s):

Sarah Patricia Cate ◽

Alyssa Gillego ◽

Manjeet Chadha ◽

John Rescigno ◽

Paul R. Gliedman ◽

...

Keyword(s):

Radiation Therapy ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Treatment Recommendations ◽

Adjuvant Radiation ◽

Adjuvant Radiation Therapy ◽

Risk Of Recurrence ◽

The Impact

91 Background: The Oncotype Dx DCIS Score has been developed and validated for risk recurrence in ductal carcinoma in situ. It is a 12 gene assay performed on an individual patient’s tumor. The results give information about the 10 year risk of any in-breast event and the 10 year risk of an invasive breast cancer. The clinical validation study was based on patients enrolled in ECOG 5194. The purpose of our study was to evaluate the impact of the DCIS Score on recommendations for adjuvant radiation therapy. Methods: In this IRB approved study, 27 patients at our institution underwent evaluation with the DCIS Score from April 2012 to February 2013. All patients had specimens submitted for DCIS Scores. 14 patients had margins of 3 mm or greater. 12 patients had margins of 1 mm to 2.5 mm, and 1 patient had margins that were less than 1 mm from the DCIS. The mean age was 56.8 years, with a range of 40-79 years old. The DCIS Score is reported on a scale of 0-100. All patients underwent consultation with radiation oncology. The radiation oncologists formulated their preliminary recommendation prior to reviewing the patients’ DCIS Scores. The final recommendation for radiation treatment was rendered after reviewing the DCIS Score. We then compared the pre-DCIS Score and post-DCIS score treatment recommendations. Results: 21 patients (78%) were advised to have adjuvant radiation therapy. 6 patients (22%) were advised not to undergo adjuvant radiation based on their clinical and pathologic features. Although the DCIS Score did not change treatment recommendations for any patient in this study group, it did confirm initial treatment recommendations. For the patients who were advised not to have radiation, their DCIS Scores were 0-31. Conclusions: The DCIS Score is a validated tool to assess the local risk of recurrence for ductal carcinoma in situ. In our study population, the results of the DCIS Score did not alter treatment in any patient. It is important to note that in the 6 patients who were advised not to have radiation, the low DCIS Score confirmed the radiation oncologist’s perceived low risk of recurrence. In order to increase confidence in results of the DCIS Score, further studies need to be performed.

Download Full-text

Radiotherapy of Ductal Carcinoma In Situ

Breast Care ◽

10.1159/000437452 ◽

2015 ◽

Vol 10 (4) ◽

pp. 259-264 ◽

Cited By ~ 9

Author(s):

David Krug ◽

Rainer Souchon

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Multidisciplinary Treatment ◽

Breast Conserving Surgery ◽

Adjuvant Radiation ◽

Recurrence Rates ◽

The Past

Ductal carcinoma in situ (DCIS) is a heterogeneous disease in both its biology and clinical course. In the past, recurrence rates after breast-conserving surgery have been as high as 30% after 10 years. The introduction of mammography screening and advances in imaging have led to an increase in the detection of DCIS. The focus of this review is on the role of radiotherapy in the multidisciplinary treatment, including current developments in hypofractionation and boost delivery, and attempts to define low-risk subsets of DCIS for which the need for adjuvant radiation is repeatedly questioned.

Download Full-text

Ductal Carcinoma in Situ: Current Concepts in Biology, Imaging, and Treatment

Journal of Breast Imaging ◽

10.1093/jbi/wbz039 ◽

2019 ◽

Vol 1 (3) ◽

pp. 166-176 ◽

Cited By ~ 10

Author(s):

Mariam Shehata ◽

Lars Grimm ◽

Nancy Ballantyne ◽

Ana Lourenco ◽

Linda R Demello ◽

...

Keyword(s):

Breast Cancer ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Breast Imaging ◽

Ductal Carcinoma ◽

Imaging Techniques ◽

Medical Community ◽

Adjuvant Radiation ◽

Imaging Features

Abstract Ductal carcinoma in situ (DCIS) of the breast is a group of heterogeneous epithelial proliferations confined to the milk ducts that nearly always present in asymptomatic women on breast cancer screening. A stage 0, preinvasive breast cancer, increased detection of DCIS was initially hailed as a means to prevent invasive breast cancer through surgical treatment with adjuvant radiation and/or endocrine therapies. However, controversy in the medical community has emerged in the past two decades that a fraction of DCIS represents overdiagnosis, leading to unnecessary treatments and resulting morbidity. The imaging hallmarks of DCIS include linearly or segmentally distributed calcifications on mammography or nonmass enhancement on breast MRI. Imaging features have been shown to reflect the biological heterogeneity of DCIS lesions, with recent studies indicating MRI may identify a greater fraction of higher-grade lesions than mammography does. There is strong interest in the surgical, imaging, and oncology communities to better align DCIS management with biology, which has resulted in trials of active surveillance and therapy that is less aggressive. However, risk stratification of DCIS remains imperfect, which has limited the development of precision therapy approaches matched to DCIS aggressiveness. Accordingly, there are opportunities for breast imaging radiologists to assist the oncology community by leveraging advanced imaging techniques to identify appropriate patients for the less aggressive DCIS treatments.

Download Full-text