title: Five year outcome of 145 patients with ductal carcinoma in situ (DCIS) after accelerated breast radiotherapy.
abstract: BACKGROUND
  Accelerated whole-breast radiotherapy (RT) with tumor bed boost in the treatment of early invasive breast cancer has demonstrated equivalent local control and cosmesis when compared with standard RT. Its efficacy in the treatment of ductal carcinoma in situ (DCIS) remains unknown.
  
  
  METHODS
  Patients treated for DCIS with lumpectomy and negative margins were eligible for 2 consecutive hypofractionated whole-breast RT clinical trials. The first trial (New York University [NYU] 01-51) prescribed to the whole breast 42 Gy (2.8 Gy in 15 fractions) and the second trial (NYU 05-181) 40.5 Gy (2.7 Gy in 15 fractions) with an additional daily boost of 0.5 Gy to the surgical cavity.
  
  
  RESULTS
  Between 2002 and 2009, 145 DCIS patients accrued, 59 to the first protocol and 86 to the second trial. Median age was 56 years and 65% were postmenopausal at the time of treatment. Based on optimal sparing of normal tissue, 79% of the patients were planned and treated prone and 21% supine. At 5 years' median follow-up (60 months; range 2.6-105.5 months), 6 patients (4.1%) experienced an ipsilateral breast recurrence in all cases of DCIS histology. In 3/6 patients, recurrence occurred at the original site of DCIS and in the remaining 3 cases outside the original tumor bed. New contralateral breast cancers arose in 3 cases (1 DCIS and 2 invasive carcinomas). Cosmetic self-assessment at least 2 years after treatment is available in 125 patients: 91% reported good-to-excellent and 9% reported fair-to-poor outcomes.
  
  
  CONCLUSIONS
  With a median follow-up of 5 years, the ipsilateral local recurrence rate is 4.1%, comparable to that reported from the NSABP (National Surgical Adjuvant Breast and Bowel Project) trials that employed 50 Gy in 25 fractions of radiotherapy for DCIS. There were no invasive recurrences. These results provide preliminary evidence that accelerated hypofractionated external beam radiotherapy is a viable option for DCIS.
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine, NYU Langone Medical Center, New York, New York, USA.
authors.forename: Raquel
authors.initials: R
authors.lastname: Ciervide
authors.forename: Shubhada
authors.initials: S
authors.lastname: Dhage
authors.forename: Amber
authors.initials: A
authors.lastname: Guth
authors.forename: Richard L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Axelrod
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Roses
authors.forename: Silvia C
authors.initials: SC
authors.lastname: Formenti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000473:pathology; D009519:New York City; D056888:Patient Positioning / Q000379:methods; D016684:Prone Position; D011446:Prospective Studies; D016683:Supine Position; D047368:Tumor Burden
chemical_list: D018931:Antineoplastic Agents, Hormonal