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Observational Study
. 2018 Feb 9;13(1):25.
doi: 10.1186/s13014-018-0964-7.

Role of postoperative radiotherapy in reducing ipsilateral recurrence in DCIS: an observational study of 1048 cases

Stefanie Corradini  1 , Montserrat Pazos  2 , Stephan Schönecker  2 , Daniel Reitz  2 , Maximilian Niyazi  2 , Ute Ganswindt  2   3 , Simone Schrodi  4 , Michael Braun  5 , Martin Pölcher  5 , Sven Mahner  6   7 , Nadia Harbeck  6   7 , Jutta Engel  4 , Claus Belka  2   7
Affiliations
Observational Study

Role of postoperative radiotherapy in reducing ipsilateral recurrence in DCIS: an observational study of 1048 cases

Stefanie Corradini et al. Radiat Oncol. .

Abstract

Background: The objective of the present study was to evaluate the effectiveness of postoperative radiotherapy after breast conserving surgery (BCS) in DCIS in a large patient population treated in clinical practice.

Methods: Data were provided by the population-based Munich Cancer Registry. Between 1998 and 2014, 1048 female patients with diagnosis of DCIS and treated at two Breast Care Centres were included in this observational study. The effectiveness of postoperative radiotherapy and variables predicting the use of radiotherapy were retrospectively analysed.

Results: After adjusting for age, tumour characteristics and therapies, Cox regression analysis for local recurrence-free survival identified RT as an independent predictor for improved local control (HR: 0.579; 95%CI: 0.384-0.872, p = 0.008). Ten-year cumulative incidence of in-breast recurrences was 20.0% following BCS, compared to 13.6% in patients receiving postoperative radiotherapy (p = 0.012). As an estimate for disease-specific survival, 10-year relative survival was 105.4% for patients receiving postoperative radiotherapy and 101.6% without radiotherapy. On multivariate analysis, postoperative radiotherapy was not associated with improved overall survival (HR 0.526; 95%CI: 0.263-1.052, p = 0.069). Over time, a significant increase of RT was registered: while 1998 only 42.9% of patients received postoperative radiotherapy, the proportion rose to 91.2% in 2014. Women aged < 50 years (OR: 2.559, 95%CI: 1.416-4.625, p < 0.001) or with negative hormone receptor status (OR: 2.625, 95%CI: 1.458-4.728, p = 0.001) or receiving endocrine therapy (OR: 1.762, 95%CI: 1.060-2.927, p = 0.029) were more likely to receive postoperative radiotherapy after BCS.

Conclusions: In conclusion, this study provides insights regarding the adoption and treatment pattern of postoperative RT following BCS for DCIS in a large cohort reflecting "real-life" clinical practice in this setting. Postoperative RT was found to be associated with a reduced risk of ipsilateral recurrence and no survival benefit compared to observation alone.

Keywords: Breast conserving surgery; Ductal carcinoma in situ; In-breast recurrence; Local control; Outcome; Radiotherapy; Survival.

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Conflict of interest statement

Ethics approval and consent to participate

This retrospective study was exempt from requiring ethics approval. Bavarian state law (Bayrisches Krankenhausgesetz/Bavarian Hospital Law §27 Absatz 4 Datenschutz (Dataprotection)) allows the use of patient data for research, provided that any person’s related data are kept anonymous. German radiation protection laws request a regular analysis of outcomes in the sense of quality control and assurance, thus in the case of purely retrospective studies no additional ethical approval is needed under German law.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The use of postoperative radiotherapy over time
Fig. 2
Fig. 2
Cumulative incidence of in-breast recurrences (a) and relative survival (b)
See this image and copyright information in PMC

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