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Extract

Treatment for DCIS

Lumpectomy is a common and effective surgery to treat ductal carcinoma in situ (DCIS), but a common failure event is ipsilateral breast tumor recurrence (IBTR). The National Surgical Adjuvant Breast and Bowel Project (NSABP) conducted two prospective randomized trials in patients with localized DCIS to compare the risk of IBTR after lumpectomy only (LO) with lumpectomy followed by radiation therapy (LRT) in the B-17 trial, and addition of tamoxifen to LRT in the B-24 trial. The most risk reduction was noted in the LRT plus tamoxifen group (published results). In an update, Wapnir et al. (p. 478 ) investigated the risk of invasive IBTR (I-IBTR) and survival in these patients after a median follow-up of more than 17 years. The 15-year cumulative incidence of I-IBTR was highly reduced in the LRT and LRT plus tamoxifen groups compared with the LO group. Survival was similar for the three groups. However, the risk of death was higher after I-IBTR. The authors conclude that adjuvant therapies remain the most effective treatment for DCIS after lumpectomy.