DUCHESS: an evaluation of the ductal carcinoma in situ score for decisions on radiotherapy in patients with low/intermediate-risk DCIS

Eileen Rakovitch^{1

2}, Sameer Parpia³, Anne Koch⁴, Laval Grimard⁵, Hany Soliman⁶, Christiaan Stevens⁷, Francisco Perera⁸, Iwa Kong³, Senti Senthelal⁹, Margaret Anthes¹⁰, Ericka Wiebe¹¹, Jeffrey Cao¹², Mira Goldberg³, Sally Smith¹³, Luciana Spadafora³, Timothy J Whelan¹⁴

Affiliations

¹ Sunnybrook Health Sciences Centre, University of Toronto, T Wing 2075 Bayview Avenue, Toronto, ON, Canada. eileen.rakovitch@sunnybrook.ca.
² IC/ES, Toronto, ON, Canada. eileen.rakovitch@sunnybrook.ca.
³ Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, Canada.
⁴ Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
⁵ The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.
⁶ Sunnybrook Health Sciences Centre, University of Toronto, T Wing 2075 Bayview Avenue, Toronto, ON, Canada.
⁷ Royal Victoria Regional Health Centre, Barrie, ON, Canada.
⁸ London Regional Cancer Centre, University of Western Ontario, London, ON, Canada.
⁹ Trillium Health Partners, Mississauga, ON, Canada.
¹⁰ Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada.
¹¹ Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
¹² Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
¹³ BC Cancer Agency, University of British Columbia, Victoria, BC, Canada.
¹⁴ Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, Canada. whelan@hhsc.ca.

PMID: 33830392
DOI: 10.1007/s10549-021-06187-7

DUCHESS: an evaluation of the ductal carcinoma in situ score for decisions on radiotherapy in patients with low/intermediate-risk DCIS

Eileen Rakovitch et al. Breast Cancer Res Treat. 2021 Jul.

. 2021 Jul;188(1):133-139.

doi: 10.1007/s10549-021-06187-7. Epub 2021 Apr 8.

Authors

Affiliations

¹ Sunnybrook Health Sciences Centre, University of Toronto, T Wing 2075 Bayview Avenue, Toronto, ON, Canada. eileen.rakovitch@sunnybrook.ca.
² IC/ES, Toronto, ON, Canada. eileen.rakovitch@sunnybrook.ca.
³ Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, Canada.
⁴ Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
⁵ The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.
⁶ Sunnybrook Health Sciences Centre, University of Toronto, T Wing 2075 Bayview Avenue, Toronto, ON, Canada.
⁷ Royal Victoria Regional Health Centre, Barrie, ON, Canada.
⁸ London Regional Cancer Centre, University of Western Ontario, London, ON, Canada.
⁹ Trillium Health Partners, Mississauga, ON, Canada.
¹⁰ Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada.
¹¹ Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
¹² Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
¹³ BC Cancer Agency, University of British Columbia, Victoria, BC, Canada.
¹⁴ Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, Canada. whelan@hhsc.ca.

PMID: 33830392
DOI: 10.1007/s10549-021-06187-7

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 (<39), 32 (15%) were in the intermediate-risk (39-54), and 45 (21%) were in the high-risk groups (≥55). The assay led to a change in treatment recommendation in 76 (35.2%) (95%CI 29.1-41.8%) patients. RT recommendations decreased from 79% pre-assay to 50% post-assay (difference = 29%; 95%CI 22-35%) due to a significant increase in the proportion of patients with a predicted low LRR (< 10%) post-assay and recommendations to omit RT for those with a low predicted risk. The assay was associated with improved patient satisfaction and reduced decisional conflict.

Conclusion: The DCIS Score assay combined with CPFs identified more women with an estimated low (<10%) 10-yr LR risk after BCS, leading to a significant decrease in recommendations for RT compared to estimates based on CPFs alone.

Keywords: Assay; DCIS; De-escalation; Ductal carcinoma in situ; Genomic; Radiotherapy.

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References

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DUCHESS: an evaluation of the ductal carcinoma in situ score for decisions on radiotherapy in patients with low/intermediate-risk DCIS

Affiliations

DUCHESS: an evaluation of the ductal carcinoma in situ score for decisions on radiotherapy in patients with low/intermediate-risk DCIS

Authors

Affiliations

Abstract

References

MeSH terms

LinkOut - more resources

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Medical