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J Clin Oncol. 2013 Nov 10;31(32):4054-9. doi: 10.1200/JCO.2013.49.5077. Epub 2013 Sep 16.

Breast-conserving treatment with or without radiotherapy in ductal carcinoma In Situ: 15-year recurrence rates and outcome after a recurrence, from the EORTC 10853 randomized phase III trial.

Author information

1
Mila Donker, Harry Bartelink, and Emiel J.T. Rutgers, The Netherlands Cancer Institute; Nina Bijker, Academic Medical Center, Amsterdam, the Netherlands; Saskia Litière, Gustavo Werutsky, and Nicole Duez, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium; Jean-Pierre Julien, Centre Henri-Becquerel, Rouen; Philippe Rouanet, Centre Régional de Lutte Contre le Cancer, Val d'Aurelle, Montpellier; Christine Tunon de Lara, Bergonie Institute, Bordeaux, France; Ian S. Fentiman, Guy's Hospital, London, United Kingdom; and Roberto Agresti, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy.

Abstract

PURPOSE:

Adjuvant radiotherapy (RT) after a local excision (LE) for ductal carcinoma in situ (DCIS) aims at reduction of the incidence of a local recurrence (LR). We analyzed the long-term risk on developing LR and its impact on survival after local treatment for DCIS.

PATIENTS AND METHODS:

Between 1986 and 1996, 1,010 women with complete LE of DCIS less than 5 cm were randomly assigned to no further treatment (LE group, n = 503) or RT (LE+RT group, n = 507). The median follow-up time was 15.8 years.

RESULTS:

Radiotherapy reduced the risk of any LR by 48% (hazard ratio [HR], 0.52; 95% CI, 0.40 to 0.68; P < .001). The 15-year LR-free rate was 69% in the LE group, which was increased to 82% in the LE+RT group. The 15-year invasive LR-free rate was 84% in the LE group and 90% in the LE+RT group (HR, 0.61; 95% CI, 0.42 to 0.87). The differences in LR in both arms did not lead to differences in breast cancer-specific survival (BCSS; HR, 1.07; 95% CI, 0.60 to 1.91) or overall survival (OS; HR, 1.02; 95% CI, 0.71 to 1.44). Patients with invasive LR had a significantly worse BCSS (HR, 17.66; 95% CI, 8.86 to 35.18) and OS (HR, 5.17; 95% CI, 3.09 to 8.66) compared with those who did not experience recurrence. A lower overall salvage mastectomy rate after LR was observed in the LE+RT group than in the LE group (13% v 19%, respectively).

CONCLUSION:

At 15 years, almost one in three nonirradiated women developed an LR after LE for DCIS. RT reduced this risk by a factor of 2. Although women who developed an invasive recurrence had worse survival, the long-term prognosis was good and independent of the given treatment.

PMID:
24043739
DOI:
10.1200/JCO.2013.49.5077
[Indexed for MEDLINE]

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