1
|
Chen Q, Campbell I, Elwood M, Cavadino A, Aye PS, Tin Tin S. Outcomes from low-risk ductal carcinoma in situ: a systematic review and meta-analysis. Breast Cancer Res Treat 2024; 208:237-251. [PMID: 39180592 DOI: 10.1007/s10549-024-07473-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/20/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE The current standard of treatment for ductal carcinoma in situ (DCIS) is surgery with or without adjuvant radiotherapy. With a growing debate about overdiagnosis and overtreatment of low-risk DCIS, active surveillance is being explored in several ongoing trials. We conducted a systematic review and meta-analysis to evaluate the recurrence of low-risk DCIS under various treatment approaches. METHODS PubMed, Embase, Web of Science, and Cochrane were searched for studies reporting ipsilateral breast tumour event (IBTE), contralateral breast cancer (CBC), and breast cancer-specific survival (BCSS) rates at 5 and 10 years in low-risk DCIS. The primary outcome was invasive IBTE (iIBTE) defined as invasive progression in the ipsilateral breast. RESULTS Thirty three eligible studies were identified, involving 47,696 women with low-risk DCIS. The pooled 5-year and 10-year iIBTE rates were 3.3% (95% confidence interval [CI]: 1.3, 8.1) and 5.9% (95% CI: 3.8, 9.0), respectively. The iIBTE rates were significantly lower in patients who underwent surgery compared to those who did not, at 5 years (3.5% vs. 9.0%, P = 0.003) and 10 years (6.4% vs. 22.7%, P = 0.008). Similarly, the 10-year BCSS rate was higher in the surgery group (96.0% vs. 99.6%, P = 0.010). In patients treated with breast-conserving surgery, additional radiotherapy significantly reduced IBTE risk, but not total-CBC risk. CONCLUSION This review showed a lower risk of progression and better survival in women who received surgery and additional RT for low-risk DCIS. However, our findings were primarily based on observational studies, and should be confirmed with the results from the ongoing trials.
Collapse
Affiliation(s)
- Qian Chen
- Faculty of Medical and Health Sciences, Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Ian Campbell
- Faculty of Medical and Health Sciences, Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Mark Elwood
- Faculty of Medical and Health Sciences, Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Faculty of Medical and Health Sciences, Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Phyu Sin Aye
- Faculty of Medical and Health Sciences, Department of Pharmacology, University of Auckland, Auckland, New Zealand
| | - Sandar Tin Tin
- Faculty of Medical and Health Sciences, Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
- Cancer Epidemiology Unit, Oxford Population Health, The University of Oxford, Oxford, UK.
| |
Collapse
|
2
|
Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy. Breast Cancer Res Treat 2021; 186:617-624. [PMID: 33675490 PMCID: PMC8019411 DOI: 10.1007/s10549-021-06129-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/04/2021] [Indexed: 12/04/2022]
Abstract
Purpose Local recurrence after treatment of ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) is more common than after mastectomy, but it is unclear if patterns of invasive recurrence vary by initial surgical therapy. Among patients with invasive recurrence after treatment for DCIS, we compared patterns of first recurrence between those originally treated with BCS vs. mastectomy. Methods From 2000 to 2016, women with an invasive recurrence occurring ≥ 6 months after initial treatment for DCIS were retrospectively identified. Clinicopathologic features and adjuvant treatment of the initial DCIS, as well as characteristics of first invasive recurrences, were compared between patients who had undergone BCS vs. mastectomy. Results 452 patients with an invasive recurrence after surgery for DCIS were identified: 367 patients (81%) had initially undergone BCS and 85 patients (19%) mastectomy. Patients originally treated with mastectomy were younger and were more likely to have had high grade, necrosis, and multifocal or multicentric DCIS (p < 0.001) compared with the BCS group. A higher proportion of invasive recurrences were local after BCS (93%; 343/367), whereas 88% (75/85) of recurrences after mastectomy were regional or distant (p < 0.001). The median time to first invasive recurrence was not different between surgical groups (BCS: 6.4 years vs. mastectomy: 5.5 years; p = 0.12). Conclusions Among women who experienced a first invasive recurrence after treatment for DCIS, those who had originally undergone mastectomy more commonly presented with advanced disease compared to those treated with BCS, likely related to the absence of the breast and the higher risk profile of their initial DCIS. Supplementary Information The online version of this article (10.1007/s10549-021-06129-3) contains supplementary material, which is available to authorized users.
Collapse
|
3
|
You KY, Bi ZF, Ma YJ, Mao YL, Zou WL, Liu YM, Yao HR. The Selection of Treatment Modality for Breast Ductal Carcinoma In Situ: Experience From a Single Institution. Cancer Control 2021; 28:1073274821997426. [PMID: 33626920 PMCID: PMC8482722 DOI: 10.1177/1073274821997426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/05/2021] [Accepted: 01/29/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Although breast conservation surgery(BCS) followed by adjuvant radiotherapy is now the mainstream treatment method for breast ductal carcinoma in situ(DCIS), mastectomy is still performed in some patients who refuse to undergo radiation. However, the most effective treatment method for these patients is still unknown. In the current study, we aimed to compare the survival rates between mastectomy and BCS plus adjuvant radiotherapy in patients with DCIS. MATERIALS AND METHODS We performed a retrospective study of 333 patients with DCIS from May 2004 to December 2016. There were 209 patents who were treated with BCS and adjuvant radiotherapy, while the remaining of 124 patients underwent mastectomy. The disease-free survival (DFS) and local recurrence-free survival(LRFS) rates were compared between the 2 treatment groups. Cox proportional hazards regression was performed to explore factors associated with DFS and LRFS. RESULTS The 10-year local recurrence(LR) rates in the mastectomy and BCS plus adjuvant radiotherapy groups were 2.6% and 7.5%, respectively. There was no difference in the LR rate between the 2 groups. Furthermore the DFS rate was also similar between the mastectomy and BCS plus adjuvant radiotherapy groups. Based on the multivariable analysis, age and tumor grade were significantly correlated with the LRFS and DFS rates. In the subgroup analysis based on the factors of age and tumor grade, patients with a tumor grade of III who underwent mastectomy had better LRFS and DFS rates compared to those who received BCS plus radiotherapy. CONCLUSION In patients with DCIS, the long-term efficacy was similar between mastectomy and BCS followed by adjuvant radiotherapy. However, in the subgroup of patients with grade III tumors, mastectomy seems to offer a better LRFS and DFS than BCS plus radiotherapy.
Collapse
Affiliation(s)
- Kai-yun You
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhuo-fei Bi
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yu-jia Ma
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yong-lin Mao
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei-liang Zou
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yi-min Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - He-rui Yao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- RNA Biomedical Institute, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
4
|
Bolukbasi Y, Sezen D, Saglam Y, Selek U. Breast Cancer. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
5
|
Toss A, Palazzo J, Berger A, Guiles F, Sendecki JA, Simone N, Anne R, Avery T, Jaslow R, Lazar M, Tsangaris T, Cristofanilli M. Clinical-pathological features and treatment modalities associated with recurrence in DCIS and micro-invasive carcinoma: Who to treat more and who to treat less. Breast 2016; 29:223-30. [PMID: 27506636 DOI: 10.1016/j.breast.2016.07.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/18/2016] [Accepted: 07/21/2016] [Indexed: 12/28/2022] Open
Abstract
The primary aim in the management of DCIS is the prevention of recurrence and contralateral tumor. Risk factors for DCIS recurrence and appropriate treatments are still widely debated. Adjuvant therapies after surgical resection reduce recurrences and contralateral disease, but these treatments have significant financial costs, side effects and there is a group of low-risk patients who would not gain additional benefit. The aim of our analysis was to identify clinical-pathological features and treatment modalities associated with recurrence in DCIS and microinvasive carcinoma. In the Thomas Jefferson University Cancer Registry of Philadelphia, we identified 865 patients with DCIS or micro-invasive carcinoma treated between 2003 and 2013. Associations between recurrence and demographic factors (age at diagnosis, ethnicity), biological features (ER, PR and HER2) and treatment modalities (surgery, radiotherapy and endocrine treatment) were assessed. Our single institution register-based study showed that distribution of age at diagnosis and biological features did not significantly differ among ethnic groups. Younger women and micro-invasive carcinoma patients were more likely to undergo mastectomy, while African Americans were more likely to take endocrine therapy and undergo radiotherapy. In our sample only ER/PR negative DCIS were associated with significantly higher recurrence rate. Moreover, we reported a high rate of HER2 positive recurrences, suggesting that expression of this oncogene may represent a potential biomarker for DCIS at high risk of recurrence. To better define the molecular profile of the subgroup at worse prognosis might help to identify biomarkers predictive of recurrence or second tumors, identifying patients candidates for more appropriate treatments.
Collapse
Affiliation(s)
- Angela Toss
- Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA.
| | - Juan Palazzo
- Department of Pathology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA
| | - Adam Berger
- Department of Surgery, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA
| | - Frances Guiles
- Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA
| | - Jocelyn Andrel Sendecki
- Department of Biostatistics, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA
| | - Nicole Simone
- Department of Radiation Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA
| | - Rani Anne
- Department of Radiation Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA
| | - Tiffany Avery
- Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA
| | - Rebecca Jaslow
- Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA
| | - Melissa Lazar
- Department of Surgery, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA
| | - Theodore Tsangaris
- Department of Surgery, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA
| | - Massimo Cristofanilli
- Department of Medical Oncology, Thomas Jefferson University & Kimmel Cancer Center, Philadelphia, PA 19107, USA
| |
Collapse
|