Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial
Jack Cuzick,Ivana Sestak,Sarah E Pinder,Ian O. Ellis,Sharon Forsyth,Nigel J Bundred,John F. Forbes,H Bishop,Ian S. Fentiman,W.D. George +9 more
TLDR
This updated analysis confirms the long-term beneficial effect of radiotherapy and reports a benefit for tamoxifen in reducing local and contralateral new breast events for women with DCIS treated by complete local excision.Abstract:
Summary Background Initial results of the UK/ANZ DCIS (UK, Australia, and New Zealand ductal carcinoma in situ) trial suggested that radiotherapy reduced new breast events of ipsilateral invasive and ductal carcinoma in situ (DCIS) compared with no radiotherapy, but no significant effects were noted with tamoxifen. Here, we report long-term results of this trial. Methods Women with completely locally excised DCIS were recruited into a randomised 2×2 factorial trial of radiotherapy, tamoxifen, or both. Randomisation was independently done for each of the two treatments (radiotherapy and tamoxifen), stratified by screening assessment centre, and blocked in groups of four. The recommended dose for radiation was 50 Gy in 25 fractions over 5 weeks (2 Gy per day on weekdays), and tamoxifen was prescribed at a dose of 20 mg daily for 5 years. Elective decision to withhold or provide one of the treatments was permitted. The endpoints of primary interest were invasive ipsilateral new breast events for the radiotherapy comparison and any new breast event, including contralateral disease and DCIS, for tamoxifen. Analysis of each of the two treatment comparisons was restricted to patients who were randomly assigned to that treatment. Analyses were by intention to treat. All trial drugs have been completed and this study is in long-term follow-up. This study is registered, number ISRCTN99513870. Findings Between May, 1990, and August, 1998, 1701 women were randomly assigned to radiotherapy and tamoxifen, radiotherapy alone, tamoxifen alone, or to no adjuvant treatment. Seven patients had protocol violations and thus 1694 patients were available for analysis. After a median follow-up of 12·7 years (IQR 10·9–14·7), 376 (163 invasive [122 ipsilateral vs 39 contralateral], 197 DCIS [174 ipsilateral vs 17 contralateral], and 16 of unknown invasiveness or laterality) breast cancers were diagnosed. Radiotherapy reduced the incidence of all new breast events (hazard ratio [HR] 0·41, 95% CI 0·30–0·56; p Interpretation This updated analysis confirms the long-term beneficial effect of radiotherapy and reports a benefit for tamoxifen in reducing local and contralateral new breast events for women with DCIS treated by complete local excision. Funding Cancer Research UK and the Australian National Health and Medical Research Council.read more
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Postoperative Tamoxifen for ductal carcinoma in situ: Cochrane systematic review and meta-analysis
TL;DR: It is concluded that while Tamoxifen after local excision forDCIS, with or without adjuvant radiotherapy, reduced the risk of recurrent DCIS, it did not reduce therisk of all-cause mortality.
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Chemoprevention Uptake among Women with Atypical Hyperplasia and Lobular and Ductal Carcinoma In Situ
TL;DR: Improving communication about breast cancer risk and chemoprevention may allow clinicians to facilitate informed decision-making about preventative therapy, according to clinicians in a population of women with atypical hyperplasia, LCIS, and DCIS.
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Clinicopathologic characteristics and molecular subtypes of microinvasive carcinoma of the breast
Li Wang,Wei Zhang,Shuhua Lyu,Shuhua Lyu,Xia Liu,Tongxian Zhang,Shan Liu,Ying Qin,Xiaoqi Tian,Yun Niu +9 more
TL;DR: A combination of pathologic, clinical, and molecular factors may ultimately reveal more powerful and robust measures for disease classification than any one modality alone.
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Role of radiotherapy boost in women with ductal carcinoma in situ: A single-center experience in a series of 389 patients
Icro Meattini,Lorenzo Livi,Davide Franceschini,Calogero Saieva,F. Meacci,Livia Marrazzo,Benedetta Bendinelli,Vieri Scotti,C. De Luca Cardillo,Jacopo Nori,Luis Jose Sanchez,Lorenzo Orzalesi,Pierluigi Bonomo,Daniela Greto,Marta Bucciolini,Simonetta Bianchi,Gianpaolo Biti +16 more
TL;DR: Results from ongoing prospective Phase III studies are strongly necessary to better identify high-risk DCIS patients and show the negative prognostic impact of surgical margins <1 mm and the protective role of radiation boost on LR rate.
Journal ArticleDOI
Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ
Elizabeth Shurell,Cristina Olcese,Sujata Patil,Beryl McCormick,Kimberly J. Van Zee,Melissa Pilewskie +5 more
TL;DR: The association between ipsilateral breast tumor recurrence (IBTR) and the timing of radiotherapy (RT) in women with ductal carcinoma in situ (DCIS) undergoing breast‐conserving surgery (BCS) is examined.
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TL;DR: Breast irradiation after lumpectomy is more appropriate than Lumpectomy alone for women with localized ductal carcinoma in situ, and five-year event-free survival was better in the women who received breast irradiation.
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Bernard Fisher,James J. Dignam,Norman Wolmark,Eleftherios P. Mamounas,Joseph P. Costantino,W. Poller,Edwin R. Fisher,D L Wickerham,Melvin Deutsch,Richard G. Margolese,Nikolay V. Dimitrov,Maureen T. Kavanah +11 more
TL;DR: Through 8 years of follow-up, findings continue to indicate that lumpectomy plus radiation is more beneficial than Lumpectomy alone for women with localized, mammographically detected DCIS.