Investigating the Effectiveness of Adjuvant Therapy for Patients with Hormone Receptor-positive Ductal Carcinoma in Situ

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2022 Jan 28

PMID 35089956

Authors

Chi-Jui Tsai

Ho-Yin Huang

Fang-Ming Chen

Yi-Hsin Yang

Li-Chia Chen

Kun-Pin Hsieh

Affiliations

Soon will be listed here.

Abstract

Background: This study compared the recurrence risk of single versus dual adjuvant radiotherapy (RT) and hormonal therapy (HT) following breast-conserving surgery (BCS) in patients with hormone receptor-positive ductal carcinoma in situ (DCIS).

Methods: This retrospective cohort study used the Taiwan Cancer Registry database linking to the Taiwan National Health Insurance data from 2011 to 2016. We compared the recurrence risk between BCS-based regimens in Cox regressions and presented as adjusted hazard ratio (HR) and 95% confidence interval (95%CI).

Results: The 1,836 study cohort with a low-to-intermediate risk of recurrence was grouped into BCS alone (6.1%), BCS+RT (6.2%), BCS+HT (23.4%) and BCS+HT+RT (64.3%) according to the initial treatments. During the follow-up (median: 3.3 years), the highest 5-year recurrence-free survival rate was in BCS+RT (94.1%) group and followed by BCS+HT+RT (92.8%), BCS+HT (87.4%) and BCS alone (84.9%). Of the single adjuvant therapies, RT was more effective than HT. Both BCS+HT (HR: 1.52, 95%CI: 0.99-2.35) and BCS+RT (HR: 1.10, 95%CI: 0.50-2.41) did not significantly increase recurrence risk comparing against the BCS+HT+RT group.

Conclusion: Single adjuvant demonstrated a similar subsequent recurrence risk with dual adjuvant. This study supports the proposition to de-escalate adjuvant treatments in patients with low-to-intermediate risk of DCIS recurrence.

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References

Wapnir I, Dignam J, Fisher B, Mamounas E, Anderson S, Julian T . 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. PMC: 3107729. DOI: 10.1093/jnci/djr027. View

Lazzeroni M, Dunn B, Pruneri G, Jereczek-Fossa B, Orecchia R, Bonanni B . Adjuvant therapy in patients with ductal carcinoma in situ of the breast: The Pandora's box. Cancer Treat Rev. 2017; 55:1-9. DOI: 10.1016/j.ctrv.2017.01.010. View

Correa C, McGale P, Taylor C, Wang Y, Clarke M, Davies C . Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010; 2010(41):162-77. PMC: 5161078. DOI: 10.1093/jncimonographs/lgq039. View

Rakovitch E, Nofech-Mozes S, Hanna W, Sutradhar R, Baehner F, Miller D . Multigene Expression Assay and Benefit of Radiotherapy After Breast Conservation in Ductal Carcinoma in Situ. J Natl Cancer Inst. 2018; 109(4). PMC: 6233855. DOI: 10.1093/jnci/djw256. View

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

Ganz P, Cecchini R, Julian T, Margolese R, Costantino J, Vallow L . Patient-reported outcomes with anastrozole versus tamoxifen for postmenopausal patients with ductal carcinoma in situ treated with lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet. 2015; 387(10021):857-65. PMC: 4792658. DOI: 10.1016/S0140-6736(15)01169-1. View

Ernster V, Ballard-Barbash R, Barlow W, Zheng Y, Weaver D, Cutter G . Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst. 2002; 94(20):1546-54. DOI: 10.1093/jnci/94.20.1546. View

Cuzick J, Sestak I, Pinder S, Ellis I, Forsyth S, Bundred N . Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol. 2010; 12(1):21-9. PMC: 3018565. DOI: 10.1016/S1470-2045(10)70266-7. View

Grantzau T, Mellemkjaer L, Overgaard J . Second primary cancers after adjuvant radiotherapy in early breast cancer patients: a national population based study under the Danish Breast Cancer Cooperative Group (DBCG). Radiother Oncol. 2013; 106(1):42-9. DOI: 10.1016/j.radonc.2013.01.002. View

10.

Gradishar W, Moran M, Abraham J, Aft R, Agnese D, Allison K . NCCN Guidelines® Insights: Breast Cancer, Version 4.2021. J Natl Compr Canc Netw. 2021; 19(5):484-493. DOI: 10.6004/jnccn.2021.0023. View

11.

MAY D, Lee N, Richardson L, Giustozzi A, Bobo J . Mammography and breast cancer detection by race and Hispanic ethnicity: results from a national program (United States). Cancer Causes Control. 2000; 11(8):697-705. DOI: 10.1023/a:1008900220924. View

12.

Dumas A, Vaz Luis I, Bovagnet T, Mouhebb M, Di Meglio A, Pinto S . Impact of Breast Cancer Treatment on Employment: Results of a Multicenter Prospective Cohort Study (CANTO). J Clin Oncol. 2019; 38(7):734-743. PMC: 7048162. DOI: 10.1200/JCO.19.01726. View

13.

Kong I, Narod S, Taylor C, Paszat L, Saskin R, Nofech-Moses S . Age at diagnosis predicts local recurrence in women treated with breast-conserving surgery and postoperative radiation therapy for ductal carcinoma in situ: a population-based outcomes analysis. Curr Oncol. 2014; 21(1):e96-e104. PMC: 3921054. DOI: 10.3747/co.21.1604. View

14.

Holmberg L, Garmo H, Granstrand B, Ringberg A, Arnesson L, Sandelin K . Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast. J Clin Oncol. 2008; 26(8):1247-52. DOI: 10.1200/JCO.2007.12.7969. View

15.

Giannakeas V, Sopik V, Narod S . Association of Radiotherapy With Survival in Women Treated for Ductal Carcinoma In Situ With Lumpectomy or Mastectomy. JAMA Netw Open. 2019; 1(4):e181100. PMC: 6324271. DOI: 10.1001/jamanetworkopen.2018.1100. View

16.

Chen S, Lo T, Chang J, Kuo H . Variations in aging, gender, menopause, and obesity and their effects on hypertension in taiwan. Int J Hypertens. 2014; 2014:515297. PMC: 4243128. DOI: 10.1155/2014/515297. View

17.

Henson K, McGale P, Taylor C, Darby S . Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer. 2012; 108(1):179-82. PMC: 3553540. DOI: 10.1038/bjc.2012.575. View

18.

Solin L, Gray R, Baehner F, Butler S, Hughes L, Yoshizawa C . 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. PMC: 3653823. DOI: 10.1093/jnci/djt067. View

19.

Allred D, Anderson S, Paik S, Wickerham D, Nagtegaal I, Swain S . Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol. 2012; 30(12):1268-73. PMC: 3341142. DOI: 10.1200/JCO.2010.34.0141. View

20.

Pistelli M, Mora A, Ballatore Z, Berardi R . Aromatase inhibitors in premenopausal women with breast cancer: the state of the art and future prospects. Curr Oncol. 2018; 25(2):e168-e175. PMC: 5927796. DOI: 10.3747/co.25.3735. View