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Is excision alone adequate for low-risk DCIS of the breast treated with breast conserving therapy

Reevaluating the role of adjuvant radiation therapy

  • Review
  • Published:
Journal of Radiation Oncology

Abstract

Background

Ductal carcinoma in situ (DCIS) represents a quarter of newly diagnosed breast neoplasms, with the majority of cases detected on routine screening mammography in asymptomatic women. Currently, most women with newly diagnosed DCIS are eligible for breast conserving therapy (BCT); however, significant controversy exists regarding whether or not to add radiation treatment (RT) after surgical excision in low-risk patients.

Results

While four older prospective randomized clinical trials have shown that the addition of RT after lumpectomy reduces the risk of ipsilateral breast tumor recurrence (IBTR) by approximately 50 %, recent studies have continued to attempt to identify a subset of patients with favorable risk DCIS who are at a sufficiently low-risk of IBTR that omitting RT might be reasonable. While a number of smaller studies have shown promising results, recent prospective data have consistently affirmed the increased risk of IBTR with the omission of RT, with no subset of patients consistently identified that can be safely observed without RT. While radiation after lumpectomy remains the “standard of care,” even in these low-risk patients, future directions include improvements in genetic assays to better identify low-risk patients and new RT techniques and schedules that can potentially reduce the duration of therapy and toxicity while improving quality of life for patients.

Conclusion

Based on the data available, we continue to recommend radiation therapy for low-risk patients with DCIS as no discernible subset has been identified that does not benefit from radiation therapy.

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Authors and Affiliations

  1. Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO, USA

    Chirag Shah

  2. Department of Surgical Oncology, Drexel University College/Allegheny General Hospital, Pittsburgh, PA, USA

    Thomas B. Julian

  3. Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA

    J. Ben Wilkinson

  4. University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Simona F. Shaitelman

  5. Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

    Atif Khan

  6. 21st Century Oncology, Scottsdale, AZ, USA

    Steven Finkelstein

  7. Michigan Healthcare Professionals/21st Century Oncology, 28595 Orchard Lake Road, Farmington Hills, MI, 48334, USA

    Frank A. Vicini

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  1. Chirag Shah
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  2. Thomas B. Julian
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  3. J. Ben Wilkinson
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  4. Simona F. Shaitelman
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Correspondence to Frank A. Vicini.

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Shah, C., Julian, T.B., Wilkinson, J.B. et al. Is excision alone adequate for low-risk DCIS of the breast treated with breast conserving therapy. J Radiat Oncol 3, 21–28 (2014). https://doi.org/10.1007/s13566-013-0089-4

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