Fredrik Wärnberg1, Hans Garmo2, Stefan Emdin2, Veronica Hedberg2, Linda Adwall2, Kerstin Sandelin2, Anita Ringberg2, Per Karlsson2, Lars-Gunnar Arnesson2, Harald Anderson2, Karin Jirström2, Lars Holmberg2. 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.
RCT Entities:
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.
Authors: Icro Meattini; Marta Scorsetti; Fiorenza De Rose; Maria Carmen De Santis; Bruno Meduri; Ciro Franzese; Davide Franceschini; Pierfrancesco Franco; Nadia Pasinetti; Valentina Lancellotta; Patrizia Giacobazzi; Eliana La Rocca; Elisa D'Angelo; Laura Lozza; Lorenzo Livi Journal: J Cancer Res Clin Oncol Date: 2021-01-02 Impact factor: 4.553
Authors: Devon Livingston-Rosanoff; Amy Trentham-Dietz; John M Hampton; Polly A Newcomb; Lee G Wilke Journal: Breast Cancer Res Treat Date: 2021-06-15 Impact factor: 4.872