Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Konkret geht es um den Diabetes-Patienten mit kardiovaskulären Erkrankungen oder Risiken, die Herzinsuffizienz sowie die kardiovaskuläre Primär- und Sekundärprävention. Sind Sie hier schon auf dem neuesten Stand? Unsere Experten beleuchten, wo und warum das bisherige Procedere geändert werden soll und was in der Praxis sinnvoll ist. Holen Sie sich Ihr Update und 2 CME-Punkte beim MMW-Webinar am 24. April von 17.30 bis 19 Uhr. 
Erweiterte Suche
Anmelden
nach oben
Annals of Surgical Oncology
Erschienen in: Annals of Surgical Oncology 2/2021

13.08.2020 | Breast Oncology

Prognostic Score-Based Stratification Analysis Reveals Universal Benefits of Radiotherapy on Lowering the Risk of Ipsilateral Breast Event for Ductal Carcinoma In Situ Patients with Different Risk Levels

verfasst von: Libo Yang, MD, PhD, Dongli Lu, PhD, Yutian Lai, MD, PhD, Mengjia Shen, MD, PhD, Qiuxiao Yu, PhD, Ting Lei, MD, PhD, Tianjie Pu, MD, PhD, Hong Bu, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 2/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

We aimed to analyze the effects of radiotherapy (RT) on the incidence rate of ipsilateral breast event (IBE) in ductal carcinoma in situ (DCIS) patients with lumpectomy after being stratified by prognostic score.

Methods

We identified DCIS patients who received lumpectomy, from the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2015. Cumulative incidence functions for competing risk were used to evaluate the effects of RT on IBE risk over time. Three multivariate regression models (weighted, non-weighted, and Fine–Gray) were applied to compare the IBE risk between the RT and non-RT groups after stratifying patients by prognostic score.

Results

Overall, 72,623 DCIS patients were identified from the SEER database and 49,206 (66.8%) patients received RT. During the follow-up period (ranging from 7 to 347 months), the cumulative probability of invasive and in situ IBE was significantly lower in the RT group than in the non-RT group (p < 0.001). After being stratified by prognostic score, the weighted IBE incidence rate increased as the risk level increased (p < 0.050). In multivariate regression models, RT lowered the IBE incidence rate by at least 30% in low-, moderate-, and high-risk DCIS (p < 0.010). In particular, the in situ and invasive IBE incidence rate decreased by over 50% in low-risk DCIS with RT (p < 0.001).

Conclusions

RT is associated with a lowered IBE incidence rate in DCIS patients, regardless of the assigned risk levels for patients. The significant reduction in the IBE incidence rate in low-risk DCIS patients also indicates the potential benefits for recommending RT to such a patient population in clinical practice.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Elshof LE, Schaapveld M, Rutgers EJ, et al. The method of detection of ductal carcinoma in situ has no therapeutic implications: results of a population-based cohort study. Breast Cancer Res. 2017;19(1):26.PubMedPubMedCentralCrossRef
2.
Olivotto IA, Bancej C, Goel V, et al. Waiting times from abnormal breast screen to diagnosis in 7 Canadian provinces. CMAJ. 2001;165(3):277–83.PubMedPubMedCentral
3.
Armed Forces Health Surveillance Center. Incident diagnoses of breast cancer, active component service women, U.S. Armed Forces, 2000–2012. MSMR. 2013;20(9):25–7.
4.
Oseni TO, Zhang B, Coopey SB, Gadd MA, Hughes KS, Chang DC. Twenty-five year trends in the incidence of ductal carcinoma in situ in US Women. J Am Coll Surg. 2019;228(6):932–9.PubMedCrossRef
5.
van Seijen M, Lips EH, Thompson AM, et al. Ductal carcinoma in situ: to treat or not to treat, that is the question. Br J Cancer. 2019;121(4):285–92.PubMedPubMedCentralCrossRef
6.
Elshof LE, Schmidt MK, Rutgers EJT, van Leeuwen FE, Wesseling J, Schaapveld M. Cause-specific mortality in a population-based cohort of 9799 women treated for ductal carcinoma in situ. Ann Surg. 2018;267(5):952–8.PubMedCrossRef
7.
Koh VC, Lim JC, Thike AA, et al. Characteristics and behaviour of screen-detected ductal carcinoma in situ of the breast: comparison with symptomatic patients. Breast Cancer Res Treat. 2015;152(2):293–304.PubMedCrossRef
8.
Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol. 2015;1(7):888–96.PubMedCrossRef
9.
Kerlikowske K, Molinaro A, Cha I, et al. Characteristics associated with recurrence among women with ductal carcinoma in situ treated by lumpectomy. J Natl Cancer Inst. 2003;95(22):1692–702.PubMedCrossRef
10.
11.
Sanders ME, Schuyler PA, Dupont WD, Page DL. The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer. 2005;103(12):2481–4.PubMedCrossRef
12.
Bijker N, Donker M, Wesseling J, den Heeten GJ, Rutgers EJ. Is DCIS breast cancer, and how do I treat it? Curr Treat Options Oncol. 2013;14(1):75–87.PubMedCrossRef
13.
Curigliano G, Burstein HJ, Winer EP, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen international expert consensus conference on the primary therapy of early breast cancer 2017. Ann Oncol. 2017;28(8):1700–12.PubMedPubMedCentralCrossRef
14.
EORTC Breast Cancer Cooperative Group, EORTC Radiotherapy Group, Bijker N, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853: a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol. 2006;24(21):3381–7.CrossRef
15.
Emdin SO, Granstrand B, Ringberg A, et al. SweDCIS: radiotherapy after sector resection for ductal carcinoma in situ of the breast. Results of a randomised trial in a population offered mammography screening. Acta Oncol. 2006;45(5):536–43.PubMedCrossRef
16.
Julien JP, Bijker N, Fentiman IS, et al. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853 EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. Lancet. 2000;355(9203):528–33.PubMedCrossRef
17.
Houghton J, George WD, Cuzick J, et al. Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial. Lancet. 2003;362(9378):95–102.PubMedCrossRef
18.
Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol. 1998;16(2):441–52.PubMedCrossRef
19.
Wapnir IL, Dignam JJ, Fisher B, 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(6):478–88.PubMedPubMedCentralCrossRef
20.
Hughes LL, Wang M, Page DL, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009;27(32):5319–24.PubMedPubMedCentralCrossRef
21.
Solin LJ, Gray R, Hughes LL, et al. Surgical excision without radiation for ductal carcinoma in situ of the breast: 12-year results from the ECOG-ACRIN E5194 study. J Clin Oncol. 2015;33(33):3938–44.PubMedPubMedCentralCrossRef
22.
Smith GL, Smith BD, Haffty BG. Rationalization and regionalization of treatment for ductal carcinoma in situ of the breast. Int J Radiat Oncol Biol Phys. 2006;65(5):1397–403.PubMedCrossRef
23.
Sagara Y, Freedman RA, Vaz-Luis I, 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(11):1190–6.PubMedPubMedCentralCrossRef
24.
25.
de Goeij MC, van Diepen M, Jager KJ, Tripepi G, Zoccali C, Dekker FW. Multiple imputation: dealing with missing data. Nephrol Dial Transplant. 2013;28(10):2415–20.PubMedCrossRef
26.
27.
Lin DY. Non-parametric inference for cumulative incidence functions in competing risks studies. Stat Med. 1997;16(8):901–10.PubMedCrossRef
28.
29.
Galimberti S, Sasieni P, Valsecchi MG. A weighted Kaplan–Meier estimator for matched data with application to the comparison of chemotherapy and bone-marrow transplant in leukaemia. Stat Med. 2002;21(24):3847–64.PubMedCrossRef
30.
Austin PC. The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med. 2014;33(7):1242–58.PubMedCrossRef
31.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.CrossRef
32.
Goh CW, Wu J, Ding S, et al. Invasive ductal carcinoma with coexisting ductal carcinoma in situ (IDC/DCIS) versus pure invasive ductal carcinoma (IDC): a comparison of clinicopathological characteristics, molecular subtypes, and clinical outcomes. J Cancer Res Clin Oncol. 2019;145(7):1877–86.PubMedCrossRef
33.
Hoorntje LE, Schipper ME, Peeters PH, Bellot F, Storm RK, Borel Rinkes IH. The finding of invasive cancer after a preoperative diagnosis of ductal carcinoma-in situ: causes of ductal carcinoma-in situ underestimates with stereotactic 14-gauge needle biopsy. Ann Surg Oncol. 2003;10(7):748–53.PubMedCrossRef
34.
Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005;353(3):229–37.PubMedCrossRef
35.
Warnberg F, Yuen J, Holmberg L. Risk of subsequent invasive breast cancer after breast carcinoma in situ. Lancet. 2000;355(9205):724–5.PubMedCrossRef
36.
Burkhardt L, Grob TJ, Hermann I, et al. Gene amplification in ductal carcinoma in situ of the breast. Breast Cancer Res Treat. 2010;123(3):757–65.PubMedCrossRef
37.
Clark SE, Warwick J, Carpenter R, Bowen RL, Duffy SW, Jones JL. Molecular subtyping of DCIS: heterogeneity of breast cancer reflected in pre-invasive disease. Br J Cancer. 2011;104(1):120–7.PubMedCrossRef
38.
Cante D, Franco P, Sciacero P, et al. Hypofractionation and concomitant boost to deliver adjuvant whole-breast radiation in ductal carcinoma in situ (DCIS): a subgroup analysis of a prospective case series. Med Oncol. 2014;31(2):838.PubMedCrossRef
39.
Guenzi M, Giannelli F, Bosetti D, et al. Two different hypofractionated breast radiotherapy schedules for 113 patients with ductal carcinoma in situ: preliminary results. Anticancer Res. 2013;33(8):3503–7.PubMed
40.
Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368(11):987–98.CrossRefPubMed
41.
Sheth GR, Cranmer LD, Smith BD, Grasso-Lebeau L, Lang JE. Radiation-induced sarcoma of the breast: a systematic review. Oncologist. 2012;17(3):405–18.PubMedPubMedCentralCrossRef
42.
Erel E, Vlachou E, Athanasiadou M, Hassan S, Chandrasekar CR, Peart F. Management of radiation-induced sarcomas in a tertiary referral centre: a review of 25 cases. Breast. 2010;19(5):424–7.PubMedCrossRef
43.
Quadros CA, Vasconcelos A, Andrade R, et al. Good outcome after neoadjuvant chemotherapy and extended surgical resection for a large radiation-induced high-grade breast sarcoma. Int Semin Surg Oncol. 2006;3:18.PubMedPubMedCentralCrossRef
44.
Kim KS, Chang JH, Choi N, et al. Radiation-induced sarcoma: a 15-year experience in a single large tertiary referral center. Cancer Res Treat. 2016;48(2):650–7.PubMedCrossRef
45.
Salminen SH, Wiklund T, Sampo MM, et al. Treatment and prognosis of radiation-associated breast angiosarcoma in a nationwide population. Ann Surg Oncol. 2020;27(4):1002–10.PubMedCrossRef
46.
Sagara Y, Mallory MA, Wong S, et al. Survival benefit of breast surgery for low-grade ductal carcinoma in situ: a population-based cohort study. JAMA Surg. 2015;150(8):739–45.PubMedCrossRef
47.
Fallowfield L, Francis A, Catt S, Mackenzie M, Jenkins V. Time for a low-risk DCIS trial: harnessing public and patient involvement. Lancet Oncol. 2012;13(12):1183–5.PubMedCrossRef
48.
McCormick B, Winter K, Hudis C, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015;33(7):709–15.PubMedPubMedCentralCrossRef
49.
Silverstein MJ. The University of Southern California/Van Nuys prognostic index for ductal carcinoma in situ of the breast. Am J Surg. 2003;186(4):337–43.PubMedCrossRef
50.
Rudloff U, Jacks LM, Goldberg JI, et al. Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol. 2010;28(23):3762–9.PubMedCrossRef
51.
Revesz E, Khan SA. What are safe margins of resection for invasive and in situ breast cancer? Oncology (Williston Park). 2011;25(10):890–5.
52.
Wang SY, Chu H, Shamliyan T, et al. Network meta-analysis of margin threshold for women with ductal carcinoma in situ. J Natl Cancer Inst. 2012;104(7):507–16.PubMedPubMedCentralCrossRef
53.
Solin LJ, Gray R, Baehner FL, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2013;105(10):701–10.PubMedPubMedCentralCrossRef
54.
Klimov S, Miligy IM, Gertych A, et al. A whole slide image-based machine learning approach to predict ductal carcinoma in situ (DCIS) recurrence risk. Breast Cancer Res. 2019;21(1):83.PubMedPubMedCentralCrossRef
55.
Page DL, Dupont WD, Rogers LW, Jensen RA, Schuyler PA. Continued local recurrence of carcinoma 15–25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy. Cancer. 1995;76(7):1197–200.PubMedCrossRef
Metadaten
Titel
Prognostic Score-Based Stratification Analysis Reveals Universal Benefits of Radiotherapy on Lowering the Risk of Ipsilateral Breast Event for Ductal Carcinoma In Situ Patients with Different Risk Levels
verfasst von
Libo Yang, MD, PhD
Dongli Lu, PhD
Yutian Lai, MD, PhD
Mengjia Shen, MD, PhD
Qiuxiao Yu, PhD
Ting Lei, MD, PhD
Tianjie Pu, MD, PhD
Hong Bu, MD, PhD
Publikationsdatum
13.08.2020
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 2/2021
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-09003-6

Weitere Artikel der Ausgabe 2/2021

Annals of Surgical Oncology 2/2021 Zur Ausgabe

Melanoma

Quantitative and Spatial Analysis of CD8+/PD-1 Tumor-Infiltrating Lymphocytes as a Predictive Biomarker for Clinical Response of Melanoma In-Transit Metastases to Topical Immunotherapy

Colorectal Cancer

The Landmark Series: Chemotherapy for Non-Metastatic Colon Cancer

Urologic Oncology

Conditional Survival and Time of Biochemical Recurrence of Localized Prostate Cancer in Japanese Patients Undergoing Laparoscopic Radical Prostatectomies

Thoracic Oncology

Digestive Reconstruction After Pharyngolaryngectomy with Total Esophagectomy

Pancreatic Tumors

Elucidating the Causes of Improved Survival in Clinical Trials of Randomized Adjuvant Pancreatic Ductal Adenocarcinoma (PDAC)

Breast Oncology

Medical Maximizing–Minimizing Preferences in Relation to Low-Value Services for Older Women with Hormone Receptor-Positive Breast Cancer: A Qualitative Study

Neu im Fachgebiet Chirurgie

17.04.2024 | Postoperative nausea and vomiting | Nachrichten

Hochrisiko-Eingriffe für postoperative Übelkeit

16.04.2024 | HNO-Chirurgie | Nachrichten

HNO-Op. auch mit über 90?

16.04.2024 | Infektiologie | Nachrichten

Kein Abstrich bei chronischen Wunden ohne Entzündungszeichen!

10.04.2024 | Postoperative Schmerztherapie | Nachrichten

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente
weitere anzeigen

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom CME-Kurs
CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur CME-Kurs
CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis CME-Kurs
CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.