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Radiotherapy in DCIS, an underestimated benefit?

Bruno Cutuli1, Jacques Bernier2, Philip Poortmans3

  • 1Institut du Cancer Courlancy, Reims, France.

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
|July 9, 2014
PubMed
Summary

Ductal carcinoma in situ (DCIS) management is debated, especially regarding postoperative radiation therapy (PORT). Recent findings link invasive local recurrence (LR) in DCIS to increased long-term mortality, highlighting the need for personalized treatment strategies.

Keywords:
Breast cancerDuctal carcinoma in situLocal recurrencePrognostic factorsRadiation therapySurgery

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Area of Science:

  • Oncology
  • Breast Cancer Research
  • Clinical Pathology

Background:

  • Ductal carcinoma in situ (DCIS) is often viewed as indolent, leading to treatment de-escalation.
  • However, invasive local recurrence (LR) following DCIS is associated with increased long-term mortality.
  • Current debates persist regarding the benefits and drawbacks of postoperative radiation therapy (PORT) for DCIS management.

Purpose of the Study:

  • To review recent biological and clinical studies on DCIS.
  • To accurately identify local recurrence (LR) risks based on tumor- and patient-related factors.
  • To analyze treatment parameters influencing patient outcomes in DCIS management.

Main Methods:

  • Literature review of recent biological and clinical studies.
  • Analysis of tumor- and patient-related factors impacting local recurrence (LR) risk.
  • Evaluation of treatment-related parameters affecting patient outcomes.

Main Results:

  • Four randomized trials provided limited insights into PORT's impact on local control due to pathological assessment variations.
  • DCIS is biologically heterogeneous, exhibiting diverse clinical behaviors.
  • Identifying patients who might be overtreated with PORT remains challenging.

Conclusions:

  • Accurate identification of LR risk factors is crucial for optimizing DCIS management.
  • Understanding tumor and patient characteristics can guide decisions on PORT.
  • Personalized treatment strategies are essential to balance efficacy and overtreatment in DCIS.