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

被引:481
作者
Bijker, Nina
Meijnen, Philip
Peterse, Johannes L.
Bogaerts, Jan
Van Hoorebeeck, Irene
Julien, Jean-Pierre
Gennaro, Massimiliano
Rouanet, Philippe
Avril, Antoine
Fentiman, Ian S.
Bartelink, Harry
Rutgers, Emiel J. Th.
机构
[1] Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Radiat Oncol, NL-1066 CX Amsterdam, Netherlands
[2] Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Surg, NL-1066 CX Amsterdam, Netherlands
[3] Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Pathol, NL-1066 CX Amsterdam, Netherlands
[4] European Org Res Treatment Canc, Ctr Data, Brussels, Belgium
[5] Ctr Henri Becquerel, Dept Surg, F-76038 Rouen, France
[6] CRLC Val DAurelle, Dept Surg, Montpellier, France
[7] Inst Bergonie, Dept Surg, Bordeaux, France
[8] Ist Nazl Tumori, Dept Surg, I-20133 Milan, Italy
[9] Guys Hosp, Dept Acad Oncol, London SE1 9RT, England
关键词
D O I
10.1200/JCO.2006.06.1366
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose The European Organisation for Research and Treatment of Cancer conducted a randomized trial investigating the role of radiotherapy (RT) after local excision (LE) of ductal carcinoma-in-situ (DCIS) of the breast. We analyzed the efficacy of RT with 10 years follow-up on both the overall risk of local recurrence (LR) and related to clinical, histologic, and treatment factors. Patients and Methods After complete LE, women with DCIS were randomly assigned to no further treatment or RT (50 Gy). One thousand ten women with mostly (71%) mammographically detected DCIS were included. The median follow-up was 10.5 years. Results The 10-year LR-free rate was 74% in the group treated with LE alone compared with 85% in the women treated by LE plus RT (log-rank P <.0001, hazard ratio [HR] = 0.53). The risk of DCIS and invasive LR was reduced by 48% (P =.0011) and 42% (P =.0065) respectively. Both groups had similar low risks of metastases and death. At multivariate analysis, factors significantly associated with an increased LR risk were young age (<= 40 years; HB = 1.89), symptomatic detection (HR = 1.55), intermediately or poorly differentiated DCIS (as opposed to well-differentiated DCIS; HR = 1.85 and HR = 1.61 respectively), cribriform or solid growth pattern (as opposed to clinging/micropapillary subtypes; HR = 2.39 and HR = 2.25 respectively), doubtful margins (HR = 1.84), and treatment by LE alone (HR = 1.82). The effect of RT was homogeneous across all assessed risk factors. Conclusion With long-term follow-up, RT after LE for DCIS continued to reduce the risk of LR, with a 47% reduction at 10 years. All patient subgroups benefited from RT.
引用
收藏
页码:3381 / 3387
页数:7
相关论文
共 34 条
[21]  
MANTEL NATHAN, 1966, CANCERCHEMOTHERAP REP, V50, P163
[22]   RELATIONSHIP OF PATIENT AGE TO PATHOLOGICAL FEATURES OF THE TUMOR AND PROGNOSIS FOR PATIENTS WITH STAGE-I OR STAGE-II BREAST-CANCER [J].
NIXON, AJ ;
NEUBERG, D ;
HAYES, DF ;
GELMAN, R ;
CONNOLLY, JL ;
SCHNITT, S ;
ABNER, A ;
RECHT, A ;
VICINI, F ;
HARRIS, JR .
JOURNAL OF CLINICAL ONCOLOGY, 1994, 12 (05) :888-894
[23]   Cell biological factors in ductal carcinoma in situ (DCIS) of the breast-relationship to ipsilateral local recurrence and histopathological characteristics [J].
Ringberg, A ;
Anagnostaki, L ;
Anderson, H ;
Idvall, I ;
Fernö, M .
EUROPEAN JOURNAL OF CANCER, 2001, 37 (12) :1514-1522
[24]   Differences in the pathologic and molecular features of intraductal breast carcinoma between younger and older women [J].
Rodrigues, NA ;
Dillon, D ;
Carter, D ;
Parisot, N ;
Haffty, BG .
CANCER, 2003, 97 (06) :1393-1403
[25]   The influence of margin width on local control of ductal carcinoma in situ of the breast [J].
Silverstein, MJ ;
Lagios, MD ;
Groshen, S ;
Waisman, JR ;
Lewinsky, BS ;
Martino, S ;
Gamagami, P ;
Colburn, WJ .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 340 (19) :1455-1461
[26]   Long-term outcome after breast-conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast [J].
Solin, LJ ;
Fourquet, A ;
Vicini, FA ;
Taylor, M ;
Olivotto, IA ;
Haffty, B ;
Strom, EA ;
Pierce, LJ ;
Marks, LB ;
Bartelink, H ;
McNeese, MD ;
Jhingran, A ;
Wai, E ;
Bijker, N ;
Campana, F ;
Hwang, WT .
CANCER, 2005, 103 (06) :1137-1146
[27]   Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial [J].
van Dongen, JA ;
Voogd, AC ;
Fentiman, IS ;
Legrand, C ;
Sylvester, RJ ;
Tong, D ;
van der Schueren, E ;
Helle, PA ;
van Zijl, K ;
Bartelink, H .
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2000, 92 (14) :1143-1150
[28]  
Van Zee KJ, 1999, CANCER-AM CANCER SOC, V86, P1757, DOI 10.1002/(SICI)1097-0142(19991101)86:9<1757::AID-CNCR18>3.0.CO
[29]  
2-V
[30]   Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserveng therapy or mastectomy [J].
Vargas, C ;
Kestin, L ;
Go, N ;
Krauss, D ;
Chen, P ;
Goldstein, N ;
Martinez, A ;
Vicini, FA .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2005, 63 (05) :1514-1521