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
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Multiple bone metastases detected 10 years after mastectomy with silicone reconstruction for DCIS and contralateral augmentation
Ryutaro Mori,Yasuko Nagao +1 more
TL;DR: The patient developed multiple bone metastases following mastectomy with silicone reconstruction and contralateral augmentation for ductal carcinoma in situ (DCIS) of the breast.
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Breast Cancer Epidemiology and Contemporary Breast Cancer Care: A Review of the Literature and Clinical Applications
TL;DR: A collaborative, multidisciplinary team approach is essential for patients and survivors to achieve optimal outcomes and enjoy productive high-quality lives as discussed by the authors , and Gynecologists, in particular, play a key role in screening and survivorship care.
Book ChapterDOI
Breast Irradiation in DCIS
TL;DR: Ductal carcinoma in situ has a potential for progression to invasive carcinoma, usually within the first 10 years after initial diagnosis, which characterizes DCIS as a preinvasive or precursor lesion and as a continuum along the mammary neoplastic transformation process.
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Carcinoma ductal in situ
TL;DR: Los trabajos de investigacion fundamental tienen por objetivo comprender mejor los mecanismos moleculares de the invasion, para meJorar the cuantificacion of los riesgos e identificar nuevas dianas capaces of prevenir the invasion.
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Postmenopausal Women with DCIS Post-Mastectomy: A Potential Role for Aromatase Inhibitors
TL;DR: Aromatase inhibitors, and perhaps particularly exemestane, provide an option to address the risk of contralateral breast cancer in postmenopausal women with DCIS managed with mastectomy.
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.