DCIS Flashcards
DCIS
handelt sich um eine Brustkrebs-Frühform in den Milchgängen, die noch nicht in das umgebende Gewebe hineingewachsen ist
Ductal carcinoma in situ
occurs when some of the cells that line a group of milk ducts within the breast have started to become cancer cells. As these cells are contained within the ducts and have not spread into the surrounding breast tissue (in situ), there is very little chance that the cells can spread into the lymph nodes or anywhere else in the body. This can be considered a very early form of breast cancer.
DCIS diagram
Management of DCIS
BCS without lymph node surgery followed by
-WBRT with or without boost to tumor bed, OR
-APBI/PBI
DCIS : Radiotherapie nach S3-LL
Die Bestrahlung des DCIS hat zum Ziel, das intramammäre Rezidivrisiko und die damit assoziierte Morbidität zu reduzieren. Sie ist jedoch kein obligater Bestandteil der brusterhaltenden Therapie des DCIS, sondern eine individuelle Therapieentscheidung, welche von klinischen, radiologischen und pathologischen Kriterien abhängig ist
Benefit of WBRT after BCS in DCIS
WBRT following BCS reduces ipsilateral breast tumor recurrence rates in DCIS by about 50%–70%.
Radiation in DCIS
Post-lumpectomy radiation for all high grade DCIS,
>2cm tumors,
<2mm margins
Pre-menopausal pts
Consider genomic assay assistance to aid in radiation decisions on post-menopausal pts with low-risk disease.
Four seminal trials of RT after BCS for DCIS
NSABP B-17
EORTC 10853
SweDCIS
UK/ANZ DCIS
All trials showed a reduction in local recurrences within the breast after BSC +RT. These trials were however run in the 80-90s and the majority of patients did not receive Tamoxifen.
Which trial addressed the question whether Tamoxifen could improve local control in DCIS?
NSABP-24
What did a combined analysis of NSABP B-17 and NSABP B-24 in women with DCIS show?
Patients who received both RT and Tamoxifen did better than those who received radiation alone (in term of invasive in-breast recurrences).
Factors determining risk of local recurrence in DCIS
palpable mass,
larger size,
higher grade,
close or involved margins, and
age <50 years.
In which situation is omission of RT in DCIS an option
if low risk DCIS and ER-positive, and endocrine therapy is offered. Selected pts with low risk may be offered APBI if they meet the definition of low-risk as per RTOG 9804.
What did NRG/RTOG 9804 test? a DCIS trial
It assessed the impact of WBI versus observation in women with good-risk ductal carcinoma in situ (DCIS), following lumpectomy. It is a DCIS trial in modern era.
RTOG 9804 short protocol
RTOG 9804 Results
