title: Ductal Carcinoma In Situ of the Breast: Evaluating the Role of Radiation Therapy in the Management and Attempts to Identify Low-risk Patients.
abstract: Ductal carcinoma in situ of the breast has rapidly increased in incidence over the past several decades secondary to an increased use of screening mammography. Local treatment options for women diagnosed with ductal carcinoma in situ include mastectomy or breast-conserving therapy. Although several randomized trials have confirmed a >50% reduction in the risk of local recurrence with the administration of radiation therapy (RT) compared with breast-conserving surgery alone, controversy persists regarding whether or not RT is needed in selected "low-risk" patients. Over the past two decades, two prospective single-arm studies and one randomized trial have been performed and confirm that the omission of RT after surgery is associated with higher rates of local recurrence even after selecting patients with optimal clinical and pathologic features. Importantly, these trials have failed to consistently and reproducibly identify a low-risk cohort of patients (based on clinical and pathologic features) that does not benefit from RT. As a result, adjuvant RT is still advocated in the majority of patients, even in low-risk cases. Future research is moving beyond traditional clinical and pathologic risk factors and instead focusing on approaches such as multigene assays and biomarkers with the hopes of identifying truly low-risk patients who may not require RT. However, recent studies confirm that even low-risk patients identified from multigene assays have higher rates of local recurrence with local excision alone than would be expected with the addition of RT.
authors.affiliation: *Department of Radiation Oncology, Summa Health System, Akron, OH †Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI ‡Department of Surgery, Division of Breast Surgical Oncology, Allegheny General Hospital, Pittsburgh, PA §Department of Radiation Oncology, Willis Knighton Health System, Shreveport, LA ∥University of Texas M.D. Anderson Cancer Center, Houston, TX ¶Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ #21st Century Oncology Translational Research Consortium, Scottsdale, AZ **Clarient Laboratory, Aliso Viejo, CA.
authors.forename: Chirag
authors.initials: C
authors.lastname: Shah
authors.forename: Frank A
authors.initials: FA
authors.lastname: Vicini
authors.forename: Sameer
authors.initials: S
authors.lastname: Berry
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Julian
authors.forename: John Ben
authors.initials: JB
authors.lastname: Wilkinson
authors.forename: Simona F
authors.initials: SF
authors.lastname: Shaitelman
authors.forename: Atif
authors.initials: A
authors.lastname: Khan
authors.forename: Steven E
authors.initials: SE
authors.lastname: Finkelstein
authors.forename: Neal
authors.initials: N
authors.lastname: Goldstein
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors