scholarly journals Outcomes of Radical and Boost Dose of Intraoperative Radiotherapy with Electron and Low KV X-Ray Based on Islamic Republic Intraoperative Radiotherapy (IRIORT) Consensus and the External Beam Radiotherapy in Pure Ductal Carcinoma in Situ (DCIS) in Breast Cancer Patients

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Solmaz Hashemi ◽  
Seyedmohammadreza Javadi ◽  
Mohammad Esmaeil Akbari ◽  
Hamid Reza Mirzaei ◽  
Seied Rabi Mahdavi
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
External Beam ◽  
X Ray ◽  
Boost Dose

Background: Radiotherapy plays an essential role in breast cancer treatment following breast conserving surgery even in good-risk patients with ductal carcinoma in situ (DCIS) histology. It can be delivered by many techniques, among which is intraoperative radiotherapy (IORT). In recent years, intraoperative radiation therapy has had the same outcome compared with EBRT. Objectives: We studied whether whole breast radiotherapy (WBRT) could safely be replaced by IORT and its ability to control local recurrence like EBRT in pure DCIS. Methods: We assigned 138 patients into the external beam radiotherapy (EBRT), radical, and boost groups. The patients were treated during the last 6 years in the Cancer Research Center of Shahid Beheshti University of Medical Sciences. A total of 57 patients received EBRT, 45 patients received the radical dose of radiotherapy by IORT (36 patients received intraoperative electron radiotherapy [IOeRT] and 9 patients received intraoperative X-ray radiotherapy [IOxRT]) according to the IRIORT consensus protocol, and 36 patients received the boost dose of radiotherapy by IORT (15 patients received IOeRT and 21 patients received IOxRT). The IORT and EBRT groups were compared. The primary endpoint was local recurrence and death and the secondary endpoint was the role of variables in local recurrence. Results: With the mean follow-up of 37 months for the IORT group and 40.1 months for the EBRT group, local recurrence occurred in 8.8% (5 patients), 13.9% (5 patients), and 2.2% (1 patient) of the patients in the EBRT, boost, and radical groups, respectively. Concerning the local recurrence, no significant difference was observed between the radical and EBRT groups (P = 0.058) and between the boost and EBRT groups (P = 0.12). Hazard ratios (HRs) of grade, hormone receptor (HR), tumor size, and age in disease-free survival were evaluated and none of these variables had a significant role in local recurrence. Conclusions: IORT is a good alternative for WBRT in DCIS patients because of its non-inferiority results in comparison with EBRT. Being careful about age, tumor size, biological markers, and margin status is of high importance when using IORT for DCIS.

scholarly journals Patient Prognostic Score and Associations With Survival Improvement Offered by Radiotherapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ: A Population-Based Longitudinal Cohort Study

2016 ◽  
Vol 34 (11) ◽  
pp. 1190-1196 ◽  
Author(s):  
Yasuaki Sagara ◽  
Rachel A. Freedman ◽  
Ines Vaz-Luis ◽  
Melissa Anne Mallory ◽  
Stephanie M. Wong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Local Recurrence ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Prognostic Score ◽  
Breast Cancer Mortality ◽  
Breast Conserving Surgery ◽  
Population Based

Purpose Radiotherapy (RT) after breast-conserving surgery (BCS) is a standard treatment option for the management of ductal carcinoma in situ (DCIS). We sought to determine the survival benefit of RT after BCS on the basis of risk factors for local recurrence. Patients and Methods A retrospective longitudinal cohort study was performed to identify patients with DCIS diagnosed between 1988 and 2007 and treated with BCS by using SEER data. Patients were divided into the following two groups: BCS+RT (RT group) and BCS alone (non-RT group). We used a patient prognostic scoring model to stratify patients on the basis of risk of local recurrence. We performed a Cox proportional hazards model with propensity score weighting to evaluate breast cancer mortality between the two groups. Results We identified 32,144 eligible patients with DCIS, 20,329 (63%) in the RT group and 11,815 (37%) in the non-RT group. Overall, 304 breast cancer–specific deaths occurred over a median follow-up of 96 months, with a cumulative incidence of breast cancer mortality at 10 years in the weighted cohorts of 1.8% (RT group) and 2.1% (non-RT group; hazard ratio, 0.73; 95% CI, 0.62 to 0.88). Significant improvements in survival in the RT group compared with the non-RT group were only observed in patients with higher nuclear grade, younger age, and larger tumor size. The magnitude of the survival difference with RT was significantly correlated with prognostic score (P < .001). Conclusion In this population-based study, the patient prognostic score for DCIS is associated with the magnitude of improvement in survival offered by RT after BCS, suggesting that decisions for RT could be tailored on the basis of patient factors, tumor biology, and the prognostic score.

Ductal Carcinoma In Situ: Challenges, Opportunities, and Uncharted Waters

2012 ◽  
pp. 40-44 ◽  
Author(s):  
Abigail W. Hoffman ◽  
Catherine Ibarra-Drendall ◽  
Virginia Espina ◽  
Lance Liotta ◽  
Victoria Seewaldt
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
The United States ◽  
Targeted Prevention ◽  
Breast Cancers ◽  
Increased Risk

Overview: Ductal carcinoma in situ (DCIS) is a heterogeneous group of diseases that differ in biology and clinical behavior. Until 1980, DCIS represented less than 1% of all breast cancer cases. With the increased utilization of mammography, DCIS now accounts for 15% to 25% of newly diagnosed breast cancer cases in the United States. Although our ability to detect DCIS has radically improved, our understanding of the pathophysiology and factors involved in its progression to invasive carcinoma is still poorly defined. In many patients, DCIS will never progress to invasive breast cancer and these women are overtreated. In contrast, some DCIS cases are clinically aggressive and the women may be undertreated. We are able to define some of the predictors of aggressive DCIS compared with DCIS of low malignant potential. However, our ability to risk-stratify DCIS is still in its infancy. Clinical risk factors that predict aggressive disease and increased risk of local recurrence include young age at diagnosis, large lesion size, high nuclear grade, comedo necrosis, and involved margins. Treatment factors such as wider surgical margins and radiation therapy reduce the risk of local recurrence. DCIS represents a key intermediate in the stepwise progression to malignancy, but not all aggressive breast cancers appear to have a DCIS intermediate, notably within triple-negative breast cancer. Ongoing studies of the genetic and epigenetic alterations in precancerous breast lesions (atypia and DCIS) as well as the breast microenvironment are important for developing effective early detection and individualized targeted prevention.

scholarly journals Single-dose intraoperative radiotherapy during lumpectomy for breast cancer: an innovative patient-centred treatment

2021 ◽  
Author(s):  
Jayant S. Vaidya ◽  
◽  
Max Bulsara ◽  
Michael Baum ◽  
Jeffrey S. Tobias
Keyword(s):  
Breast Cancer ◽  
Single Dose ◽  
Local Recurrence ◽  
External Beam Radiotherapy ◽  
Intraoperative Radiotherapy ◽  
External Beam ◽  
Breast Cancer Outcome ◽  
Cancer Outcome

SummaryIn the randomised TARGIT-A trial, risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy was non-inferior to whole-breast external beam radiotherapy, for local recurrence. In the long-term, no difference was found in any breast cancer outcome, whereas there were fewer deaths from non-breast-cancer causes. TARGIT-IORT should be included in pre-operative consultations with eligible patients.

Patterns of Fractionation and Boost Usage in Adjuvant External Beam Radiotherapy for Ductal Carcinoma in Situ in the United States

2018 ◽  
Vol 18 (3) ◽  
pp. 220-228 ◽  
Author(s):  
William A. Stokes ◽  
Arya Amini ◽  
Matthew W. Jackson ◽  
S. Reed Plimpton ◽  
Nicole Kounalakis ◽  
...  
Keyword(s):  
United States ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
External Beam Radiotherapy ◽  
The United States ◽  
External Beam

scholarly journals Breast Conserving Surgery and Intraoperative Electron Radiotherapy (IOERT) Among Cases of Ductal Carcinoma In Situ

2019 ◽  
pp. 83-89
Author(s):  
Nahid Nafissi ◽  
Athena Farahzadi ◽  
Zahra Zeinali ◽  
Hamidreza Mirzaei ◽  
Hasan Moayeri ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Intraoperative Radiation Therapy ◽  
Intraoperative Radiation ◽  
Boost Dose ◽  
Electron Radiotherapy

Background: Ductal Carcinoma In Situ (DCIS) which has recently been renamed into Ductal Intraepithelial Neoplasia (DIN), is a malignant cell proliferation without invasion to basement membrane of ducts or lobules of breast. DCIS consists 20-30% of newly diagnosed breast cancers in some Western countries due to higher diagnosis resulting from screening by mammography. Relative Risk (RR) of invasive ductal carcinoma is 8-10 times in DCIS, although high grading lesions and positive or close surgical margins are two important predictive factors in DCIS recurrences. The adjuvant radiotherapy has decreased the rate of ipsilateral local recurrence about 60%. In this article, we evaluated the recurrence rate as DCIS as well as invasive breast cancer in patients with DCIS undergoing breast conserving surgery (BCS) and intraoperative electron radiotherapy (IOERT).Methods: Data were derived from Cancer Research Center database from 38 pure DCIS cases who had received intraoperative radiation therapy between 2012–2017. Intraoperative electron radiotherapy (IOERT) was performed according to Iran's intraoperative radiation therapy consensus.Results: The median age of the patients was 55 years and median histological lesion size was 1.8 centimeters. Number of extracted lymph nodes had a median of 1 and all extracted nodes were negative. Hormonal therapy was performed in 42.1% of patients. IOERT was done as radical full exposure for 86.9% of cases and as boost dose for 13.1% of cases, who needed to complete radiotherapy by external beam. One case in the group received boost dose and 4 cases in the group received full dose had recurrence. The median follow-up of patients was 31 months. Pathology of recurrence was reported as DCIS in 3 cases and invasive breast cancer in 2 of them.Conclusion: There is not a lot of data on the effectiveness of IOERT in DCIS management. Although there are not large number of cases in our study, the local recurrence (13.1%) was only event in our study with 31 months median follow up with no contralateral metastasis, distant metastasis, or death.

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