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Role of boost radiotherapy for local control of pure ductal carcinoma in situ after breast-conserving surgery: a multicenter, retrospective study of 622 patients

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Abstract

Purpose

To evaluate the effect of boost radiotherapy on ipsilateral breast tumor recurrence (IBTR) for ductal carcinoma in situ (DCIS) after breast-conserving surgery and whole breast radiotherapy (WBRT) with or without boost.

Methods and materials

Retrospective, multicentre study of 622 patients (624 tumors) diagnosed with pure DCIS from 1993–2011.

Results

Most tumors (377/624; 60.4%) received a boost. At a median follow-up of 8.8 years, IBTR occurred in 64 cases (10.3%). A higher percentage of patients with risk factors for IBTR received a boost (p < 0.05). Boost was not associated with lower rates of IBTR than WBRT alone (HR 0.75, 95% CI 0.42–1.35). On the univariate analyses, IBTR was significantly associated with tumor size (11–20 mm, HR 2.32, 95% CI 1.27–4.24; and > 20 mm, HR 2.10, 95% CI 1.14–3.88), re-excision (HR 1.76, 95% CI 1.04–2.96), and tamoxifen (HR 2.03, 95% CI 1.12–3.70). Boost dose > 16 Gy had a protective effect (HR 0.39, 95% CI 0.187–0.824). Multivariate analyses confirmed the independent associations between IBTR and 11–20 mm (p = 0.02) and > 20 mm (p = 0.009) tumours, and re-excision (p = 0.006). On the margin-stratified multivariate analysis, tamoxifen was a poor prognostic factor in the close/positive margin subgroup (HR 4.28 95% CI 1.23–14.88), while the highest boost dose ( > 16 Gy) had a significant positive effect (HR 0.34, 95% CI 0.13–0.86) in the negative margin subgroup.

Conclusions

Radiotherapy boost did not improve the risk of IBTR. Boost radiotherapy was more common in patients with high-risk disease. Tumor size and re-excision were significant independent prognostic factors.

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References

  1. Kerlikowske K. Epidemiology of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010:139–41.

    Article  Google Scholar 

  2. Boyages J, Delaney G, Taylor R. Predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Cancer. 1999;85:616–28.

    Article  CAS  Google Scholar 

  3. Wapnir IL, Dignam JJ, Fisher B, Mamounas EP, Anderson SJ, Julian TB, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J. Natl. Cancer Inst. 2011;103:478–88.

    Article  Google Scholar 

  4. Donker M, Litiere S, Weruski G, Julien JP, Fentiman IS, Agresti R, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma in situ: 15 year recurrence rates and outcome after a recurrence, from EORTC 10583 randomized phase III trial. J. Clin. Oncol. 2013;31:4054–9.

    Article  Google Scholar 

  5. Emdin SO, Grandstrand B, Ringberg A, Sandelin K, Arnesson LG, Nordgren H, et al. SweDCIS: radiotherapy after sector resection for ductal carcinoma in situ of the breast. Results of a randomized trial in a population offered mammographic screening. Acta Oncol. 2006;45:536–43.

    Article  Google Scholar 

  6. Cuzick J, Sestak I, Pinder SE, Ellis IO, Forsyth S, Bundred NJ, et al. Effect of tamoxifen and radiotherapy in women with completely excised ductal carcinoma in situ: long-term results from the UK/AN DCIS trial. Lancet Oncol. 2011;12:21–9.

    Article  CAS  Google Scholar 

  7. McCormick B, Winter K, Hudis C, Kuerer HM, Rakovitch E, Sneige BN, et al. RTOG 9804: A prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J. Clin. Oncol. 2015;33:709–15.

    Article  CAS  Google Scholar 

  8. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Correa C, McGale P, Taylor C, Wang Y, Clarke M, Davies C, et al. Overview of the randomized trial of radiotherapy in ductal carcinoma in situ of the breast. J. Natl. Cancer Inst. Monog. 2010;41:162–77.

    Article  Google Scholar 

  9. Sagara Y, Freedman RA, Vaz-Luis I, Mallory MA, Wong SM, Aydogan F, et al. Patient prognostic score and associations with survival improvement offered by radiotherapy after breast-conserving surgery for ductal carcinoma in situ: a population-based longitudinal cohort study. J. Clin. Oncol. 2016;34:1190–6.

    Article  CAS  Google Scholar 

  10. Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, Jager JJ, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881–10882 trial. J. Clin. Oncol. 2007;25:3259–65.

    Article  Google Scholar 

  11. Nilsson C, Valachis A. The role of boost and hypofractionation as adjuvant radiotherapy in patients with DCIS: a meta-analysis of observational studies. Radiother. Oncol. 2015;114:50–5.

    Article  Google Scholar 

  12. Cutuli B, Wiezzane N, Palumbo I, Barbieri P, Guenzi M, Huscher A, et al. Breast-conserving treatment for ductal carcinoma in situ: impact of boost and tamoxifen on local recurrences. Cancer Radiother. 2016;20:292–8.

    Article  CAS  Google Scholar 

  13. Moran MS, Zhao Y, Ma S, Kirova Y, Fourquet A, Chen P, et al. Association of radiotherapy boost for ductal carcinoma in situ with local control after whole-breast radiation therapy. JAMA Oncol. 2017;3:1060–8.

    Article  Google Scholar 

  14. Azria D, Cowen D, Bourgier C, de la Lande B, Gourgou-Bourgade S, Douadi Gaci Z, et al. Phase III randomized French multicentric study to evaluate the impact of a localized 16-Gy boost after conservative surgery and a 50-Gy whole-breast irradiation in breast ductal carcinoma in situ (the BONBIS trial). J. Clin. Oncol. 2011 [Epub ahead of print]. https://doi.org/10.1200/jco.2011.29.15_suppl.tps131.

    Article  Google Scholar 

  15. TROG (Trans Tasman Radiation Oncology Group) Cancer Research. ActiveTROG trials, TROG 07.01 a randomized phase III study of radiation doses and fractionation schedules in non-low risk ductal carcinoma in situ (DCIS) of the breast. https://clinicaltrials.gov/ct2/show/NCT00470236?term=boost+AND+DCIS&rank=1 (accessed prior to 30 November 2012).

  16. Cambra MJ, Farrús B, Moreno F, Anglada L, Arenas M, Ballester R, et al. Management of breast ductal carcinoma in situ in Catalonia, Spain: results from the Grup oncologic Calalà–Occità–Catalonia survey with 9-year follow up. Breast. 2017;35:196–202.

    Article  CAS  Google Scholar 

  17. Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Ann. Surg. Oncol. 2016;23:3801–10.

    Article  Google Scholar 

  18. Vicini FA, Kestin LL, Goldstein NS, Baglan KL, Pettinga JE, Martinez AA. Relationship between excision volume, margin status, and tumor size with the development of local recurrence in patients with ductal carcinoma-in-situ treated with breast-conserving therapy. J. Surg. Oncol. 2001;76:245–54.

    Article  CAS  Google Scholar 

  19. Silverstein MJ, Lagios MD, Craig PH, Waisman JR, Lewinsky BS, Colburn WJ, et al. A prognostic index for ductal carcinoma in situ of the breast. Cancer. 1996;77:2267–74.

    Article  CAS  Google Scholar 

  20. Rudloff U, Jacks LM, Goldberg JI, Wynveen CA, Brogi E, Patil S, et al. Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J. Clin. Oncol. 2010;28:3762–9.

    Article  Google Scholar 

  21. Marinovich ML, Azizi L, Macaskill P, Irwig L, Morrow M, Solin L, et al. The association of surgical margins and local recurrence in women with ductal carcinoma in situ treated with breast-conserving therapy: a meta-Analysis. Ann. Surg. Oncol. 2016;23:3811–21.

    Article  Google Scholar 

  22. Dunne C, Burke JP, Morrow M, Kell MR. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J. Clin. Oncol. 2009;27:1615–20.

    Article  Google Scholar 

  23. Van Zee KJ, Subhedar P, Olcese C, Patil S, Morrow M. Relationship between margin width and recurrence of ductal carcinoma in situ: analysis of 2996 women treated with breast-conserving surgery for 30 years. Ann. Surg. 2015;262:623–31.

    PubMed  PubMed Central  Google Scholar 

  24. Wang SY, Chu H, Shamliyan T, Jalal H, Kuntz KM, Kane RL, et al. Network meta-analysis of margin threshold for women with ductal carcinoma in situ. J. Natl. Cancer Inst. 2012;104:507–16.

    Article  Google Scholar 

  25. Kantor O, Winchester DJ. Breast conserving therapy for DCIS—does size matter? J. Surg. Oncol. 2014;110:75–81.

    Article  Google Scholar 

  26. Cheng L, Al-Kaisi N, Gordon NH, Liu AY, Gebrail F, Shenk RR. Relationship between the size and margin status of ductal carcinoma in situ of the breast and residual disease. J. Natl. Cancer Inst. 1997;89:1356–60.

    Article  CAS  Google Scholar 

  27. Wai E, Lesperance M, Alexander CS, Truong PT, Culp M, Moccia P, et al. Effect of radiotherapy boost and hypofractionation outcomes in ductal carcinoma in situ. Cancer. 2011;117:54–62.

    Article  Google Scholar 

  28. Monteau A, Sigal-Zafrani B, Kirova Y, Fourchotte V, Bollet MA, Vicent-Salomon A, et al. Ductal carcinoma in situ of the breast with close or focally involved margins following breast conserving surgery: treatment with reexcision or radiotherapy with increased dosage. Int. J. Rad. Oncol. Biol. Phys. 2009;75:1021–8.

    Article  Google Scholar 

  29. Van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European organization therapy with mastectomy: European organization for research and treatment of cancer 10801 trial. J Natl Cancer Inst. 2000;92:1143–50.

    Article  Google Scholar 

  30. Meattini I, Livi L, Franceschini D, et al. Role of radiotherapy boost in women with ductal carcinoma in situ: a single-center experience in a series of 389 patients. Eur J Surg Oncol. 2013;39:613–8.

    Article  CAS  Google Scholar 

  31. Omlin A, Amichetti M, Azria D, Cole BF, Fourneret P, Poortmans P, et al. Boost radiotherapy in young women with ductal carcinoma in situ: a multicentre retrospective study of the Rare Cancer Network. Lancet Oncol. 2006;8:652–6.

    Article  Google Scholar 

  32. Julian TB, Land SR, Wang Y, Vicini F, Arthur D, Mamounas EP, et al. Is boost therapy necessary in the treatment of DCIS? J. Clin. Oncol. 2008. https://doi.org/10.1200/jco.2008.26.15_suppl.537.

    Article  PubMed  Google Scholar 

  33. Brouers PJ, van Verkhoven E, Bartelink H, Fourquet A, Lemanski C, van Loon J, et al. Factors associated with patient-reported cosmetic outcome in the Young Boost Breast Trial. Radiother Oncol. 2016;120:107–13.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Dr. Bruno Cutuli for his helpful advice and to Bradley Londres for revising the English text. This work was supported by a grant from the Clìnic Barcelona and the Institut d’ Investigació i Innovació Parc Taulí.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Hospital Universitari General de Catalunya-Grupo Quirónsalud (IOV-HGC-Quironsalud), Carrer Pedro i Pons 1, 08195, Sant Cugat del Vallés, Barcelona, Spain

    M. J. Cambra

  2. Department of Radiation Oncology, Institut Català d’Oncologia L’Hospitalet, L’Hospitalet de Llobregat, Avda de la Granvia, 199, 08908, Barcelona, Spain

    F. Moreno & M. Macià

  3. Department of Radiation Oncology, Parc de Salut MAR, Passeig Marítim 25-29, 08003, Barcelona, Spain

    X. Sanz

  4. Department of Radiation Oncology, ICO Girona, Avda de França, s/n, 17007, Girona, Spain

    L. Anglada

  5. Department of Radiation Oncology, Hospital Vall d’Hebrón, Pg Vall d’Hebron 119, 129, 08035, Barcelona, Spain

    M. Mollà & V. Reyes

  6. Department of Radiation Oncology, Hospital Clìnic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain

    M. Mollà, B. Farrús & A. Biete

  7. Department of Radiation Oncology, Hospital Universitari Sant Joan Reus, Avda del Dr. Josep Laporte, 2, 43204, Reus, Tarragona, Spain

    M. Arenas

  8. Department of Radiation Oncology, Hospital Plató, c/Plató, 21, 08006, Barcelona, Spain

    A. Pedro

  9. Department of Radiation Oncology, Institut Català D’Oncologia-Badalona, Carretera del Canyet, s/n, 08916, Badalona, Barcelona, Spain

    R. Ballester

  10. Department of Radiation Oncology, Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure, 80, 25198, Lleida, Spain

    V. García

  11. Department of Radiation Oncology, Hospital Quirón, Plaça Alfonso Comín, 5, 08023, Barcelona, Spain

    J. Casals

  12. Department of Gynecology and Obstetrics, Hospital Universitari Dexeus-Grupo Quirónsalud, c/Sabino Arana, 5-19, 08028, Barcelona, Spain

    M. Cusidó

  13. Biostatistics and Bioinformatic Expert, Olesa de Montserrat, c/Urgell 55 A, 08640, Barcelona, Spain

    C. Jimenez

  14. Catalan Cancer Registry, Cancer Planning Directorate, L’Hospitalet de Llobregat, Avda de La Granvia, s/n, 08908, Barcelona, Spain

    J. M. Escribà

  15. Department of Clinical Sciences, University of Barcelona, Barcelona, Spain

    J. M. Escribà

  16. Department of Radiation Oncology, Consorci Sanitari de Terrassa, Ctra. Torrebonica s/n, 08227, Terrassa, Barcelona, Spain

    J. M. Solé

  17. Department of Medical Oncology, Ctra. Torrebonica s/n, Consorci Sanitari de Terrassa, 08227, Terrassa, Barcelona, Spain

    A. Arcusa

  18. Department of Medical Oncology, Corporació Sanitaria Parc Taulí, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain

    M. A. Seguí

  19. Department of Medical Oncology, Hospital Universitari Mútua de Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain

    S. Gonzalez

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  1. M. J. Cambra
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  2. F. Moreno
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  3. X. Sanz
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  9. R. Ballester
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  10. V. García
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  14. J. M. Escribà
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  19. S. Gonzalez
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  20. B. Farrús
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  21. A. Biete
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Correspondence to M. J. Cambra.

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The authors declare that they have no competing interests.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national Research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Institutional review board approval and data sharing agreements were obtained from all participating institutions. All data were anonymized.

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Preliminary results from this study have been presented at the XVIII Congress of the Spanish Society of Radiation Oncology in Valencia, Spain (June, 2015); at the European Cancer Congress in Vienna, Austria (September, 2015); and at the San Antonio Breast Cancer Symposium (December 2015).

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Cambra, M.J., Moreno, F., Sanz, X. et al. Role of boost radiotherapy for local control of pure ductal carcinoma in situ after breast-conserving surgery: a multicenter, retrospective study of 622 patients. Clin Transl Oncol 22, 670–680 (2020). https://doi.org/10.1007/s12094-019-02168-x

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