Abstract With the widespread adoption of screening mammography, the incidence of ductal carcinoma in situ (DCIS) has been dramatically increased. The spectrum of local treatment advances from mastectomy to breast conservation surgery plus whole breast irradiation (WBI), and hypofractionated WBI or accelerated partial breast irradiation. Although the efficacy of WBI on reducing local recurrence is clear, such benefit in the low-risk DCIS is still controversial. Further studies are required to establish a more precise local recurrence risk stratification system for better tailoring local treatment in patients with DCIS. In this review, the latest advances and controversies in surgery, radiation therapy and local recurrence risk stratification system for patients with DCIS were summarized.
Corresponding Authors:
Cao Lu, Email:caolu_163@ymail.com
Cite this article:
Xu Feifei,Chen Jiayi,Cao Lu. Research progress and controversies of individualized local treatment of breast ductal carcinoma in situ[J]. Chinese Journal of Radiation Oncology, 2021, 30(2): 208-212.
Xu Feifei,Chen Jiayi,Cao Lu. Research progress and controversies of individualized local treatment of breast ductal carcinoma in situ[J]. Chinese Journal of Radiation Oncology, 2021, 30(2): 208-212.
[1] Barrio AV, Van Zee KJ. Controversies in the treatment of ductal carcinoma in situ[J]. Annu Rev Med, 2017, 68:197-211. DOI:10.1146/annurev-med-050715-104920. [2] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. DOI:10.3322/caac.21492. [3] Han MS, Khan SA. Clinical trials for ductal carcinoma in situ of the breast[J]. J Mammary Gland Biol Neoplasia, 2018, 23(4):293-301. DOI:10.1007/s10911-018-9413-3. [4] Sagara Y, Freedman RA, Wong SM, et al. Trends in adjuvant therapies after breast-conserving surgery for hormone receptor-positive ductal carcinoma in situ:findings from the national cancer database, 2004-2013[J]. Breast Cancer Res Treat, 2017, 166(2):583-592. DOI:10.1007/s10549-017-4436-9. [5] Stuart KE, Houssami N, Taylor R, et al. Long-term outcomes of ductal carcinoma in situ of the breast:a systematic review, meta-analysis and meta-regression analysis[J]. BMC Cancer, 2015, 15:890. DOI:10.1186/s12885-015-1904-7. [6] 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]. J Natl Cancer Inst, 2011, 103(6):478-488. DOI:10.1093/jnci/djR027. [7] Morrow M, Van Zee KJ, Solin LJ, 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[J]. Ann Surg Oncol, 2016, 23(12):3801-3810. DOI:10.1200/JCO.2016.68.3573. [8] Chehade HEH, Headon H, Wazir U, et al. Is sentinel lymph node biopsy indicated in patients with a diagnosis of ductal carcinoma in situ? A systematic literature review and meta-analysis[J]. Am J Surg, 2017, 213(1):171-180. DOI:10.1016/j.amjsurg. 2016.04.019. [9] Lyman GH, Somerfield MR, Bosserman LD, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer:American Society of Clinical Oncology clinical practice guideline update[J]. J Clin Oncol, 2017, 35(5):561-564. DOI:10.1200/JCO.2016.71.0947. [10] 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[J]. JAMA Surg, 2015, 150(8):739-745. DOI:10.1001/jamasurg.2015.0876. [11] Cuzick J, Sestak I, Pinder SE, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ:long-term results from the UK/ANZ DCIS trial[J]. Lancet Oncol, 2011, 12(1):21-29. DOI:10.1016/s1470-2045.(10)70266-7. [12] Donker M, Litiere S, Werutsky G, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma in situ:15-year recurrence rates and outcome after a recurrence, from the EORTC 10853 randomized phase Ⅲ trial[J]. J Clin Oncol, 2013, 31(32):4054-4059. DOI:10.1200/JCO.2013.49.5077. [13] Warnberg F, Garmo H, Emdin S, et al. Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ:20 years follow-up in the randomized SweDCIS trial[J]. J Clin Oncol, 2014, 32(32):3613-3618. DOI:10.1200/JCO.2014.56.2595. [14] Early Breast Cancer Trialists′ Collaborative Group (EBCTCG), Collaborative G, Correa C, et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast[J]. J Natl Cancer Inst Monogr, 2010, 2010(41):162-177. DOI:10.1093/jncimonographs/lgq039. [15] Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer[J]. New Engl J Med, 2010, 362(6):513-520. DOI:10.1056/NEJMoa0906260. [16] Haviland JS, Owen JR, Dewar JA, et al. The UK standardisation of breast radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer:10-year follow-up results of two randomised controlled trials[J]. Lancet Oncol, 2013, 14(11):1086-1094. DOI:10.1016/S1470-2045.(13)70386-3. [17] Coles CE, Griffin CL, Kirby AM, et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial):5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial[J]. Lancet, 2017, 390(10099):1048-1060. DOI:10.1016/S0140-6736.(17)31145-5. [18] Lalani N, Paszat L, Sutradhar R, et al. Long-term outcomes of hypofractionation versus conventional radiation therapy after breast-conserving surgery for ductal carcinoma in situ of the breast[J]. Int J Radiat Oncol Biol Phys, 2014, 90(5):1017-1024. DOI:10.1016/j.ijrobp.2014.07.026. [19] Groen EJ, Elshof LE, Visser LL, et al. Finding the balance between over-and under-treatment of ductal carcinoma in situ (DCIS)[J]. Breast, 2017, 31:274-283. DOI:10.1016/j.breast.2016.09.001. [20] McCormick B. Randomized trial evaluating radiation following surgical excision for “good risk” DCIS:12-year report from NRG/RTOG 9804[J]. Int J Radiat Oncol Biol Phys, 2018, 102(5):1603. DOI:10.1016/J. IJROBP.2018.08.048. [21] Correa C, Harris EE, Leonardi MC, et al. Accelerated partial breast irradiation:executive summary for the update of an ASTRO evidence-based consensus statement[J]. Pract Radiat Oncol, 2017, 7(2):73-79. DOI:10.1016/j.prro.2016.09.007. [22] Strnad V, Ott OJ, Hildebrandt G, et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast:a randomised, phase 3, non-inferiority trial[J]. Lancet, 2016, 387(10015):229-238. DOI:10.1016/S0140-6736.(15)00471-7. [23] Vicini F, Cecchini R, White J, et al.Abstract GS4-04:primary results of NSABP B-39/RTOG 0413(NRG oncology):a randomized phase Ⅲ study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, Ⅰ, or Ⅱ breast cancer[G]. SABCS, 2019. [24] Whelan T, Julian J, Levine M, etal.AbstractGS4-03:RAPID:A randomized trial of accelerated partial breast irradiation using 3-dimensional conformal radiotherapy (3D-CRT)[G]. SABCS, 2019. [25] Moran MS, Zhao Y, Ma S, et al. Association of radiotherapy boost for ductal carcinoma in situ with local control after whole-breast radiotherapy[J]. JAMA Oncol, 2017, 3(8):1060-1068. DOI:10.1001/jamaoncol.2016.6948. [26] Cutuli B, Wiezzane N, Palumbo I, et al. Breast-conserving treatment for ductal carcinoma in situ:impact of boost and tamoxifen on local recurrences[J]. Cancer Radiother, 2016, 20(4):292-298. DOI:10.1016/j.canrad.2016.04.004. [27] Meattini I, Pasinetti N, Meduri B, et al. A national multicenter study on 1072 DCIS patients treated with breast-conserving surgery and whole breast radiotherapy (COBCG-01 study)[J]. Radiother Oncol, 2018, 131:208-214. DOI:10.1016/j.radonc.2018.07.015. [28] Kuo SH, Lo C, Chen YH, et al. Prognostic significance of clinicopathologic features in patients with breast ductal carcinoma-in-situ who received breast-conserving surgery[J]. Clin Breast Cancer, 2018, 18:441-450. DOI:10.1016/j.clbc.2018.04.002. [29] Poulakaki N, Makris GM, Papanota AM, et al. Ki-67 expression as a factor predicting recurrence of ductal carcinoma in situ of the breast:a systematic review and meta-analysis[J]. Clin Breast Cancer, 2018, 18(2):157-167. DOI:10.1016/j.clbc.2017.12.007. [30] Rauch GM, Hobbs BP, Kuerer HM, et al. Microcalcifications in 1657 patients with pure ductal carcinoma in situ of the breast:correlation with clinical, histopathologic, biologic features, and local recurrence[J]. Ann Surg Oncol, 2016, 23(2):482-489. DOI:10.1245/s10434-015-4876-6. [31] Silverstein MJ. The university of Southern California/Van Nuys prognostic index for ductal carcinoma in situ of the breast[J]. Am J Surg, 2003, 186(4):337-343. DOI:10.1016/s0002-9610.(03)00265-4. [32] Rakovitch E, Nofech-Mozes S, Hanna W, et al. A population-based validation study of the DCIS score predicting recurrence risk in individuals treated by breast-conserving surgery alone[J]. Breast Cancer Res Treat, 2015, 152(2):389-398. DOI:10.1007/s10549-015-3464-6. [33] Rakovitch E, Gray R, Baehner FL, et al. Refined estimates of local recurrence risks by DCIS score adjusting for clinicopathological features:a combined analysis of ECOG-ACRIN E5194 and ontario DCIS cohort studies[J]. Breast Cancer Res Treat, 2018, 169(2):359-369. DOI:10.1007/s10549-018-4693-2.
2021, Vol. 30 
