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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Behaviour and characteristics of low-grade ductal carcinoma in situ of the breast: literature review and single-centre retrospective series.
Valerie Cui Yun Koh,Jeffrey Chun Tatt Lim,Aye Aye Thike,Aye Aye Thike,Poh Yian Cheok,Minn Minn Myint Thu,Huihua Li,Veronique Kiak Mien Tan,Kong Wee Ong,Benita Kiat Tee Tan,Shyamala Thilagaratnam,Jill Su Lin Wong,Fuh Yong Wong,Ian O. Ellis,Puay Hoon Tan,Puay Hoon Tan +15 more
TL;DR: A comprehensive literature review of the behaviour, outcomes and current management trials of low‐grade DCIS, as well as a retrospective study of a large single institutional series of low-gradeDCIS diagnosed at the hospital are carried out.
Journal ArticleDOI
Prognostic Significance of Clinicopathologic Features in Patients With Breast Ductal Carcinoma-in-Situ Who Received Breast-Conserving Surgery.
Sung-Hsin Kuo,Chiao Lo,Yu-Hsuan Chen,Huang-Chun Lien,Wen-Hung Kuo,Ming-Yang Wang,Yi-Hsuan Lee,Chiun-Sheng Huang +7 more
TL;DR: RT reduces the risk of IBTR after BCS for DCIS of the breast, and patients with combined low‐risk characteristics (USC/VNPI scores 4‐6 and meeting the ECOG E5194 cohort 1 criteria) may be adequately treated with BCS alone.
Journal ArticleDOI
Large and diffuse ductal carcinoma in situ: potentially lethal subtypes of "preinvasive" disease.
TL;DR: In this paper, the authors identify whether patients with DCIS larger than 5 cm and diffuse-type DCIS differ from patients with disease less than 5cm in breast cancer mortality.
Journal ArticleDOI
Advances and controversies in management of breast ductal carcinoma in situ (DCIS)
G. Farante,Antonio Toesca,Francesca Magnoni,Germana Lissidini,Jose Vila,Mauro G. Mastropasqua,Giuseppe Viale,Silvia Penco,Enrico Cassano,Matteo Lazzeroni,Bernardo Bonanni,Maria Cristina Leonardi,Francisco Ripoll-Orts,Giuseppe Curigliano,Roberto Orecchia,Viviana Galimberti,P. Veronesi +16 more
TL;DR: In this paper, the authors suggest evidence-based guidelines for proper DCIS clinical management, which should be discussed within a multidisciplinary team in order to propose the most suitable approach in clinical practice, taking into account recent scientific studies.
Journal ArticleDOI
Are There Alternative Strategies for the Local Management of Ductal Carcinoma in Situ
TL;DR: In this paper, randomized controlled trials have been established to test the outcomes (invasive breast cancer outcomes and patient-reported outcome measures) of active surveillance compared with guideline-concordant care for low-risk (for progression) DCIS.
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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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