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J Clin Oncol. 2014 Nov 10;32(32):3613-8. doi: 10.1200/JCO.2014.56.2595. Epub 2014 Oct 13.

Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial.

Author information

1
Fredrik Wärnberg, Hans Garmo, Linda Adwall, and Lars Holmberg, Uppsala University, Uppsala; Stefan Emdin, Umeå University Hospital, Umeå; Veronica Hedberg, Gävle Hospital, Gävle; Kerstin Sandelin, Karolinska University Hospital, Stockholm; Anita Ringberg, Skåne University Hospital, Malmö; Anita Ringberg, Harald Anderson, and Karin Jirström, Lund University, Lund; Per Karlsson, Sahlgrenska University Hospital, Göteborg; Lars-Gunnar Arnesson, Linköping University Hospital, Linköping, Sweden; and Hans Garmo and Lars Holmberg, King's College London Medical School, London, United Kingdom. fredrik.warnberg@akademiska.se.
2
Fredrik Wärnberg, Hans Garmo, Linda Adwall, and Lars Holmberg, Uppsala University, Uppsala; Stefan Emdin, Umeå University Hospital, Umeå; Veronica Hedberg, Gävle Hospital, Gävle; Kerstin Sandelin, Karolinska University Hospital, Stockholm; Anita Ringberg, Skåne University Hospital, Malmö; Anita Ringberg, Harald Anderson, and Karin Jirström, Lund University, Lund; Per Karlsson, Sahlgrenska University Hospital, Göteborg; Lars-Gunnar Arnesson, Linköping University Hospital, Linköping, Sweden; and Hans Garmo and Lars Holmberg, King's College London Medical School, London, United Kingdom.

Abstract

PURPOSE:

Four randomized studies show that adjuvant radiotherapy (RT) lowers the risk of subsequent ipsilateral breast events (IBEs) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) by approximately 50% after 10 to 15 years. We present 20 years of follow-up data for the SweDCIS trial.

PATIENTS AND METHODS:

Between 1987 and 1999 1,046 women were randomly assigned to RT or not after BCS for primary DCIS. Results up to 2005 have been published, and we now add another 7 years of follow-up. All breast cancer events and causes of death were registered.

RESULTS:

There were 129 in situ and 129 invasive IBEs. Absolute risk reduction in the RT arm was 12.0% at 20 years (95% CI, 6.5 to 17.7), with a relative risk reduction of 37.5%. Absolute reduction was 10.0% (95% CI, 6.0 to 14.0) for in situ and 2.0% (95% CI, -3.0 to 7.0) for invasive IBEs. There was a nonstatistically significantly increased number of contralateral events in the RT arm (67 v 48 events; hazard ratio, 1.38; 95% CI, 0.95 to 2.00). Breast cancer-specific death and overall survival were not influenced. Younger women experienced a relatively higher risk of invasive IBE and lower effect of RT. The hazard over time looked different for in situ and invasive IBEs.

CONCLUSION:

Use of adjuvant RT is supported by 20-year follow-up. Modest protection against invasive recurrences and a possible increase in contralateral cancers still call for a need to find groups of patients for whom RT could be avoided or mastectomy with breast reconstruction is indicated.

PMID:
25311220
DOI:
10.1200/JCO.2014.56.2595
[Indexed for MEDLINE]

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