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No Radiation Following Lumpectomy for Ductal Carcinoma in Situ: Presented at NCCN

By Ed Susman

HOLLYWOOD, Fla -- March 10, 2008 -- Radiation therapy may be omitted in some patients following lumpectomy for the treatment of ductal carcinoma in situ (DCIS) according to the Breast Cancer Guidelines Committee of the National Comprehensive Cancer Network (NCCN).

The Committee presented the guidelines here on March 8 at the NCCN's 13th Annual Conference: Clinical Practice Guidelines and Quality Cancer Care.

"This represents a major change in the breast cancer guidelines," stated Stephen B. Edge, MD, Professor of Surgery, State University of New York at Buffalo, and Interim Chair, Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York. Previous guidelines differentiated between small, low-grade DCIS and larger cancers in allowing women with smaller tumours to opt out of radiation following surgery.

While radiation therapy reduces the risk of local recurrence, Dr. Edge said studies have found no apparent overall survival benefit for patients with DCIS who receive radiation following lumpectomy. "No controlled data show any survival difference by type of treatment," he noted.

The new guidelines eliminate the category referring to the size and grade of the DCIS, and now suggest that in patients diagnosed with DCIS at stage Ia with no nodal disease and no metastases, the choice of treatments are as follows: (1) lumpectomy without lymph node surgery plus whole-breast radiation therapy, (2) total mastectomy with or without sentinel node biopsy, with or without breast reconstruction, or (3) lumpectomy without lymph node surgery, without radiation therapy.

In a footnote explaining the change, the guideline committee wrote, "Whole-breast radiation therapy following lumpectomy reduces recurrence rates in DCIS by about 50%. Approximately half of the recurrences are invasive, and half are DCIS. A number of factors determine local recurrence risk, including size, tumour grade, margin status, and patient age."

"Some patients may be treated by excision alone, if the patient and physician view the individual risks as 'low,'" noted Dr. Edge. "All data evaluating the three local treatments show no difference in patient survival."

Dr. Edge concluded that the new guidelines essentially "place the onus on the physician to have a discussion with the patient as to which procedure should be used."


[Presentation title: Update: Breast Cancer Guidelines.]

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