DUCHESS: an evaluation of the ductal carcinoma in situ score for decisions on radiotherapy in patients with low/intermediate-risk DCIS.
| Title: | DUCHESS: an evaluation of the ductal carcinoma in situ score for decisions on radiotherapy in patients with low/intermediate-risk DCIS. |
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| Authors: | Rakovitch E; Sunnybrook Health Sciences Centre, University of Toronto, T Wing 2075 Bayview Avenue, Toronto, ON, Canada. eileen.rakovitch@sunnybrook.ca.; IC/ES, Toronto, ON, Canada. eileen.rakovitch@sunnybrook.ca.; Parpia S; Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, Canada.; Koch A; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.; Grimard L; The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.; Soliman H; Sunnybrook Health Sciences Centre, University of Toronto, T Wing 2075 Bayview Avenue, Toronto, ON, Canada.; Stevens C; Royal Victoria Regional Health Centre, Barrie, ON, Canada.; Perera F; London Regional Cancer Centre, University of Western Ontario, London, ON, Canada.; Kong I; Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, Canada.; Senthelal S; Trillium Health Partners, Mississauga, ON, Canada.; Anthes M; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada.; Wiebe E; Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.; Cao J; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.; Goldberg M; Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, Canada.; Smith S; BC Cancer Agency, University of British Columbia, Victoria, BC, Canada.; Spadafora L; Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, Canada.; Whelan TJ; Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, Canada. whelan@hhsc.ca. |
| Source: | Breast cancer research and treatment [Breast Cancer Res Treat] 2021 Jul; Vol. 188 (1), pp. 133-139. Date of Electronic Publication: 2021 Apr 08. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Kluwer Academic Country of Publication: Netherlands NLM ID: 8111104 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1573-7217 (Electronic) Linking ISSN: 01676806 NLM ISO Abbreviation: Breast Cancer Res Treat Subsets: MEDLINE |
| Imprint Name(s): | Publication: Dordrecht : Kluwer Academic; Original Publication: The Hague ; Boston : M. Nijhoff, c1981- |
| MeSH Terms: | Carcinoma, Intraductal, Noninfiltrating*/surgery ; Breast Neoplasms* ; Carcinoma, Ductal, Breast*; Female ; Humans ; Mastectomy, Segmental ; Middle Aged ; Neoplasm Recurrence, Local ; Prospective Studies |
| Abstract: | Background: Identification of women with DCIS who have a very low risk of local recurrence risk (LRR) after breast-conserving surgery (BCS) is needed to de-escalate therapy. We evaluated the impact of 10-year LRR estimates after BCS, calculated by the integration of a 12-gene molecular expression assay (Oncotype Breast DCIS Score®) and clinicopathological features (CPFs), on its ability to change radiation oncologists' recommendations for RT after BCS for DCIS.; Methods: Prospective cohort study of women with DCIS treated with BCS. Eligibility criteria were as follows: age > 45 years, tumor ≤ 2.5 cm, and margins ≥ 1 mm. Radiation oncologists provided 10-year LRR estimates without RT and recommendation for RT pre- and post-assay. Primary outcome was change in RT recommendation.; Results: 217 patients were evaluable, with mean age = 63 years, mean tumor size = 1.1 cm, and mean DCIS Score = 32; 140 (64%) were in the low-risk ( |
| References: | Cancer NCPGB (2020).; Worni M, Akushevich I, Greenup R, Sarma D, Ryser MD, Myers ER, Hwang ES (2015) Trends in treatment patterns and outcomes for ductal carcinoma in situ. JNCI. https://doi.org/10.1093/jnci/djv263. (PMID: 10.1093/jnci/djv263266834054849804); Hwang ES, Hyslop T, Lynch T, Frank E, Pinto D, Basila D, Collyar D, Bennett A, Kaplan C, Rosenberg S, Thompson A, Weiss A, Partridge A (2019) The COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial: a phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS). BMJ Open 9(3):e026797. https://doi.org/10.1136/bmjopen-2018-026797. (PMID: 10.1136/bmjopen-2018-02679764298996429899); Francis A, Fallowfield L, Rea D (2015) The LORIS trial: addressing overtreatment of ductal carcinoma in situ. Clin Oncol (R Coll Radiol) 27(1):6–8. https://doi.org/10.1016/j.clon.2014.09.015. (PMID: 10.1016/j.clon.2014.09.015); Elshof LE, Tryfonidis K, Slaets L, van Leeuwen-Stok AE, Skinner VP, Dif N, Pijnappel RM, Bijker N, Rutgers EJ, Wesseling J (2015) Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ - The LORD study. Eur J Cancer (Oxford, England) 51(12):1497–1510. https://doi.org/10.1016/j.ejca.2015.05.008. (PMID: 10.1016/j.ejca.2015.05.008); Paik S, Shak S, Tang G, Kim C, Baker J, Cronin M, Baehner FL, Walker MG, Watson D, Park T, Hiller W, Fisher ER, Wickerham DL, Bryant J, Wolmark N (2004) A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med 351(27):2817–2826. https://doi.org/10.1056/NEJMoa041588. (PMID: 10.1056/NEJMoa041588); Solin LJ, Gray R, Baehner FL, Butler SM, Hughes LL, Yoshizawa C, Cherbavaz DB, Shak S, Page DL, Sledge GW Jr, Davidson NE, Ingle JN, Perez EA, Wood WC, Sparano JA, Badve S (2013) A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst 105(10):701–710. https://doi.org/10.1093/jnci/djt067. (PMID: 10.1093/jnci/djt067236410393653823); Rakovitch E, Nofech-Mozes S, Hanna W, Baehner FL, Saskin R, Butler SM, Tuck A, Sengupta S, Elavathil L, Jani PA, Bonin M, Chang MC, Robertson SJ, Slodkowska E, Fong C, Anderson JM, Jamshidian F, Miller DP, Cherbavaz DB, Shak S, Paszat L (2015) A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone. Breast Cancer Res Treat 152(2):389–398. https://doi.org/10.1007/s10549-015-3464-6. (PMID: 10.1007/s10549-015-3464-6261191024491104); Rakovitch E, Gray R, Baehner FL, Sutradhar R, Crager M, Gu S, Nofech-Mozes S, Badve SS, Hanna W, Hughes LL, Wood WC, Davidson NE, Paszat L, Shak S, Sparano JA, Solin LJ (2018) Refined estimates of local recurrence risks by DCIS score adjusting for clinicopathological features: a combined analysis of ECOG-ACRIN E5194 and Ontario DCIS cohort studies. Breast Cancer Res Treat 169(2):359–369. https://doi.org/10.1007/s10549-018-4693-2. (PMID: 10.1007/s10549-018-4693-2293880155945747); Paszat L, Sutradhar R, Zhou L, Nofech-Mozes S, Rakovitch E (2019) Including the Ductal Carcinoma-In-Situ (DCIS) score in the development of a multivariable prediction model for recurrence after excision of DCIS. Clin Breast Cancer 19(1):35–46. https://doi.org/10.1016/j.clbc.2018.07.018. (PMID: 10.1016/j.clbc.2018.07.01830190195); O’Connor AM (1995) Validation of a decisional conflict scale. Med Decis Making 15(1):25–30. https://doi.org/10.1177/0272989x9501500105. (PMID: 10.1177/0272989x95015001057898294); Rudloff U, Jacks LM, Goldberg JI, Wynveen CA, Brogi E, Patil S, Van Zee KJ (2010) Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol 28(23):3762–3769. (PMID: 10.1200/JCO.2009.26.8847); Silverstein MJ, Lagios MD (2015) Treatment selection for patients with ductal carcinoma in situ (DCIS) of the breast using the University of Southern California/Van Nuys (USC/VNPI) prognostic index. Breast J 21(2):127–132. https://doi.org/10.1111/tbj.12368. (PMID: 10.1111/tbj.1236825600630); McCormick B, Winter K, Hudis C, Kuerer HM, Rakovitch E, Smith BL, Sneige N, Moughan J, Shah A, Germain I, Hartford AC, Rashtian A, Walker EM, Yuen A, Strom EA, Wilcox JL, Vallow LA, Small W Jr, Pu AT, Kerlin K, White J (2015) RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol 33(7):709–715. https://doi.org/10.1200/JCO.2014.57.9029. (PMID: 10.1200/JCO.2014.57.9029256058564334775); Solin LJ, Gray R, Hughes LL, Wood WC, Lowen MA, Badve SS, Baehner FL, Ingle JN, Perez EA, Recht A, Sparano JA, Davidson NE (2015) Surgical excision without radiation for ductal carcinoma in situ of the breast: 12-year results from the ECOG-ACRIN E5194 study. J Clin Oncol 33(33):3938–3944. https://doi.org/10.1200/JCO.2015.60.8588. (PMID: 10.1200/JCO.2015.60.8588263711484652014); Wong JS, Kaelin CM, Troyan SL, Gadd MA, Gelman R, Lester SC, Schnitt SJ, Sgroi DC, Silver BJ, Harris JR, Smith BL (2006) Prospective study of wide excision alone for ductal carcinoma in situ of the breast. J Clin Oncol 24(7):1031–1036. https://doi.org/10.1200/jco.2005.02.9975. (PMID: 10.1200/jco.2005.02.997516461781); Rakovitch E, Nofech-Mozes S, Narod S, Hanna W, Thiruchelvam D, Saskin R, Taylor C, Tuck A, Sengupta S, Elavathil L, Jani P, Done S, Miller N, Youngson B, Kong I, Paszat L (2013) Can we select individuals with low risk ductal carcinoma in situ (DCIS)? a population-based outcomes analysis. Breast Cancer Res Treat 138(2):581–590. (PMID: 10.1007/s10549-013-2455-8); Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer CE Jr, Dees EC, Perez EA, Olson JA Jr, Zujewski J, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin P, Keane MM, Gomez Moreno HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Atkins JN, Berenberg JL, Sledge GW (2015) Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med 373(21):2005–2014. https://doi.org/10.1056/NEJMoa1510764. (PMID: 10.1056/NEJMoa15107642641234926412349); Sparano JA, Gray RJ, Ravdin PM, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer CE Jr, Dees EC, Goetz MP, Olson JA Jr, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Keane MM, Gomez Moreno HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge GW Jr (2019) Clinical and genomic risk to guide the use of adjuvant therapy for breast cancer. N Engl J Med 380(25):2395–2405. https://doi.org/10.1056/NEJMoa1904819. (PMID: 10.1056/NEJMoa190481967096716709671); Alvarado M, Carter DL, Guenther JM, Hagans J, Lei RY, Leonard CE, Manders J, Sing AP, Broder MS, Cherepanov D, Chang E, Eagan M, Hsiao W, Schultz MJ (2015) The impact of genomic testing on the recommendation for radiation therapy in patients with ductal carcinoma in situ: a prospective clinical utility assessment of the 12-gene DCIS score result. J Surg Oncol 111(8):935–940. https://doi.org/10.1002/jso.23933. (PMID: 10.1002/jso.2393326031501); Manders JB, Kuerer HM, Smith BD, McCluskey C, Farrar WB, Frazier TG, Li L, Leonard CE, Carter DL, Chawla S, Medeiros LE, Guenther JM, Castellini LE, Buchholz DJ, Mamounas EP, Wapnir IL, Horst KC, Chagpar A, Evans SB, Riker AI, Vali FS, Solin LJ, Jablon L, Recht A, Sharma R, Lu R, Sing AP, Hwang ES, White J (2017) Clinical utility of the 12-gene DCIS score assay: impact on radiotherapy recommendations for patients with ductal carcinoma in situ. Ann Surg Oncol 24(3):660–668. https://doi.org/10.1245/s10434-016-5583-7. (PMID: 10.1245/s10434-016-5583-727704370) |
| Contributed Indexing: | Keywords: Assay; DCIS; De-escalation; Ductal carcinoma in situ; Genomic; Radiotherapy |
| Entry Date(s): | Date Created: 20210408 Date Completed: 20210629 Latest Revision: 20210629 |
| Update Code: | 20260130 |
| DOI: | 10.1007/s10549-021-06187-7 |
| PMID: | 33830392 |
| Database: | MEDLINE |
Journal Article