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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Book ChapterDOI
Ductal Carcinoma In Situ
Nuran Bese,Ayfer Ay +1 more
TL;DR: Treatment approach for patients with DCIS and the role of radiotherapy will be discussed and the lack of clarity and the incomplete data regarding the natural history, prognostic factors, and biology of DCIS remain unanswered.
Journal ArticleDOI
Ductal Carcinoma in Situ: A French National Survey. Analysis of 2125 Patients.
Bruno Cutuli,Claire Lemanski,Brigitte de Lafontan,Marie-Pierre Chauvet,Christine Tunon de Lara,Alice Mege,Daniele Fric,Marion Richard-Molard,Chafica Mazouni,Caroline Cuvier,Agnes Carre,Youla Kirova +11 more
TL;DR: The clinical practice identified in this survey complies with French DCIS guidelines and about 10% of patients with low-grade DCIS may be eligible to participate in treatment de-escalation trials.
Journal ArticleDOI
Explaining the Better Prognosis of Screening-Exposed Breast Cancers: Influence of Tumor Characteristics and Treatment
Nathalie J. Massat,Peter Sasieni,Daniela Tataru,Dharmishta Parmar,Jack Cuzick,Stephen W. Duffy +5 more
TL;DR: The results suggest that earlier diagnosis, as reflected by tumor characteristics, remains the major mediator of the improvement in breast cancer survival due to participation in mammographic screening.
Journal ArticleDOI
A national multicenter study on 1072 DCIS patients treated with breast-conserving surgery and whole breast radiotherapy (COBCG-01 study).
Icro Meattini,Nadia Pasinetti,Bruno Meduri,Fiorenza De Rose,Maria De Santis,Pierfrancesco Franco,Valentina Lancellotta,F. Rossi,Calogero Saieva,Isacco Desideri,Camilla Delli Paoli,Elisa D'Angelo,Luca Triggiani,Paolo Bastiani,Filippo Alongi,Laura Lozza,Cynthia Aristei,Umberto Ricardi,Marta Scorsetti,Lorenzo Livi +19 more
TL;DR: A real-life study pointed out the significant favorable prognostic role of postmenopausal state and ER positive status on LR occurrence and FSM <1 mm was significantly correlated to a higher chance to experience LR.
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TL;DR: The combination of lumpectomy, radiation therapy, and tamoxifen was effective in the prevention of invasive cancer and the risk of ipsilateral-breast cancer was lower in the tamoxIFen group even when sample margins contained tumour and when DCIS was associated with comedonecrosis.
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Lumpectomy Compared with Lumpectomy and Radiation Therapy for the Treatment of Intraductal Breast Cancer
Bernard Fisher,Joseph P. Costantino,Carol K. Redmond,Edwin R. Fisher,Richard G. Margolese,Nikolay V. Dimitrov,Norman Wolmark,Wickerham Dl,Melvin Deutsch,L Ore +9 more
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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Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17.
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.