Omitting Adjuvant Radiation Post Partial Mastectomy in DCIS

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Studies continue to evaluate for a subset of patients with DCIS who may not require adjuvant radiation therapy following breast-conserving surgery
  • In a prospective nonrandomized trial, ECOG E5194 evaluated two cohorts of patients:
    • Groups:
      • Group 1 had ≤ 2.5-cm low- and intermediate- grade DCIS
      • Group 2 had ≤ 1 cm high-grade DCIS
    • Both cohorts had margins of at least 3 mm and did not receive adjuvant radiation therapy
    • Tamoxifen was given to 30% of patients
    • Local recurrence at 5 years was:
      • 6.1% in group 1 and 15.3% in group 2
    • The rate at 12 years was:
      • 14.4% in group 1 and 24.6% in group 2
    • There was no plateau in the incidence of local recurrence over time
  • The Radiation Therapy Oncology Group (RTOG) 9804 study:
    • Randomized patients with < 2.5 cm low- and intermediate-grade DCIS and margins ≥ 3 mm to adjuvant radiation or no radiation therapy following partial mastectomy
    • Seven-year outcomes demonstrated an increase in local recurrence with the omission of radiation therapy (6.7% vs. 0.9%)
    • Tamoxifen was given to 62% of patients
  • Similar outcomes were also noted in the Dana Farber Cancer Institute prospective trial of excision alone
  • Trials are currently underway evaluating the omission of surgery for low-risk DCIS including:
    • The COMET (grade 1/2 ADH/DCIS ER+, primary outcome: ipsilateral invasive cancer at 2 years) – data recently published
    • The LORD (age > 45, primary outcome: ipsilateral invasive breast cancer free rate at 10 years)
    • LORIS trials:
      • However, there is limited prospective data published with respect to outcomes for patients forgoing surgery.
  • References:
    • McCormick B, Winter K, Hudis C, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015;33(7):709-715.
    • Solin LJ, Gray R, Hughes LL, et al. Surgical excision without radiation for ductal carcinoma in situ of the breast: 12-year results from the ECOG-ACRIN E5194 study. J Clin Oncol. 2015;33(33):3938-3944.
    • Wong JS, Kaelin CM, Troyan SL, et al. Prospective study of wide excision alone for ductal carcinoma in situ of the breast. J Clin Oncol. 2006;24(7):1031-1036.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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