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
Citations
More filters
Journal ArticleDOI
Breast Ductal Carcinoma In Situ: A Literature Review of Adjuvant Hormonal Therapy.
TL;DR: Key endpoint analyses were risk of invasive and noninvasive malignancies and new contralateral breast cancers, and subgroup analysis of DCIS populations in multiple studies showed a trend to benefit with aromatase inhibitor treatment.
Journal ArticleDOI
Benefit of tamoxifen in estrogen receptor positive DCIS of the breast
Petrelli Fausto,Sandro Barni +1 more
TL;DR: A retrospective analysis of the benefits of tamoxifen in ductal carcinoma in situ according to the estrogen receptor status shows the centralisation of receptor analysis, in the majority of cases, according to standard immunohistochemical analysis.
Journal ArticleDOI
Multidisciplinary Shared Decision Making in the Management of Ductal Carcinoma In Situ of the Breast.
Priya Parikh,Barbara A. Pockaj,Nabil Wasif,Michele Y. Halyard,William W. Wong,Heidi E. Kosiorek,Amylou C. Dueck,Richard Gray +7 more
TL;DR: Reasonable 5-year local recurrence rates suggest that multidisciplinary and joint decision making in the treatment of DCIS results in a substantial and increasing number of patients forgoing adjuvant RT, adjUvant HT, or both.
Journal ArticleDOI
Die adjuvante Nachbestrahlung reduziert die Lokalrezidivrate auch beim prognostisch günstigen DCIS der Brust signifikant
René Pahl,Jürgen Dunst +1 more
TL;DR: Endpunkte waren kumulative Inzidenz von Lokalrezidiven und von kontralateralen Karzinomen sowie krankheitsfreies Überleben und Gesamtüberlebensrate.
Journal ArticleDOI
Low-risk DCIS. What is it? Observe or excise?
TL;DR: The issue of overdiagnosis and overtreatment of lesions detected by breast screening mammography has been debated in both international media and the scientific literature as discussed by the authors, and the most likely entity which may represent those overdiagnosed and overtreated is low-grade ductal carcinoma in situ (DCIS).
References
More filters
Journal ArticleDOI
Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials.
Mike Clarke,Rory Collins,Sarah C. Darby,C Davies,P. Elphinstone,V Evans,J Godwin,Richard Gray,C. Hicks,Spencer L. James,E MacKinnon,Paul McGale,T McHugh,Richard Peto,Carolyn W. Taylor,Yaochen Wang +15 more
TL;DR: It is found that variations in local treatment that substantially affect the risk of locoregional recurrence could also affect long-term breast cancer mortality, and that avoidance of a local recurrence in the conserved breast is recommended.
Journal ArticleDOI
Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial
B Fisher,James J. Dignam,Norman Wolmark,D. Lawrence Wickerham,Edwin R. Fisher,Eleftherios P. Mamounas,Roy E. Smith,Mirsada Begovic,Nikolay V. Dimitrov,Richard G. Margolese,Carl G Kardinal,Maureen T. Kavanah,Louis Fehrenbacher,Robert H Oishi +13 more
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.
Journal Article
Effects of adjuvant tamoxifen and of cytotoxic therapy on mortality in early breast cancer. An overview of 61 randomized trials among 28,896 women
I. C. Henderson,H. Mouridsen,O. Abe,M. Abeloff,D. Ahmann,K. Andersen,M. Baum,A. R. Bianco,F. Boccardo,G. Bonadonna,M. Buyse,Aman U. Buzdar,P. Carbone,J. Carpenter,R. Chlebowski,Rory Collins,R. Cooper,J. Crowley,Jack Cuzick +18 more
TL;DR: This overview was able to demonstrate particularly clearly that both tamoxifen and cytotoxic therapy can reduce five-year mortality, and showed that combination chemotherapy was significantly more effective than single-agent therapy.
Journal ArticleDOI
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.
Journal ArticleDOI
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.