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Radiation boost for DCIS patients undergoing whole-breast radiation (WBRT) is the age-old trade-off in conventional oncology. Does the patient want to reduce her risk of ipsilateral breast tumor recurrence or reduce her risk of side effects?
I want to be clear about adding a boost of radiation at the end of whole-breast radiation. As the studies linked and excerpted below state, boost therapy does reduce the risk of ipsilateral breast tumor recurrence but does not change overall survival statistics. Boost therapy will not help you live longer.
But boost therapy does increase the rate of severe fibrosis.
I am a long-term survivor of a much different kind of cancer called multiple myeloma. Though my cancer is considered to be “incurable” by conventional oncology, there are surprising similarities between DCIS and MM.
I have lived in complete remission from my cancer since 1999 by living an evidence-based, non-toxic, non-conventional lifestyle through supplementation, nutrition, bone health, detoxification and more.
To learn more about DCIS and the evidence-based therapies that can help you prevent its spread into invasive breast cancer, please watch the video below:
Have you been diagnosed with either DCIS or early-stage breast cancer? Scroll down the page, post a question or comment and I will reply to you ASAP.
“A 20-year follow-up of patients with early-stage breast cancer shows that boosting them with an extra radiotherapy dose to the tumor bed after breast-conserving surgery significantly decreases the rate of local disease recurrence and the need for salvage mastectomy but has no effect on overall survival.
Results of the so-called EORTC 22881-10882 trial show that “no extra complications or second malignancies are caused by the higher radiation dose. On the other hand, we can reduce the need for mastectomies by 35%,” lead investigator Harry Bartelink, MD, from The Netherlands Cancer Institute in Amsterdam, told Medscape Medical News.
However, compared with patients who did not receive the radiotherapy boost, those who did had almost triple the rate of severe fibrosis at 10, 15, and 20 years after treatment, the study showed…
The trial enrolled patients with early stage I and II breast cancer following complete excision with breast-conserving surgery and whole-breast irradiation (50 Gy)…
Previous results from the study at a median of 10.8 years of follow-up (J Clin Oncol. 2007;25:3259-3265) showed a local recurrence rate in favor of the boost group (6.2% vs 10.2%; hazard ratio [HR], 0.59; P < .0001), with the largest absolute risk reduction in younger patients (40 years or younger), but no difference between treatment arms in terms of overall survival…
Similar to the earlier findings, younger patients (up to 40 years) had the most benefit from the boost in terms of local recurrence (HR, 0.56; P .003), but the beneficial effects were also seen in the other age groups (41 to 50 years: HR, 0.66 [P = .007]; 51 to 60 years: HR, 0.69 [P = .020]; and 60 years or older: HR, 0.66 [P = .019], respectively).
However, at 20 years the boost and nonboost groups did not differ for rate of overall survival (61.1% in the nonboost group vs 59.7% in the boost group; HR, 1.05; P = .323). This was seen regardless of age, Dr. Bartelnik said. “Even in the youngest age group there is absolutely no difference in overall survival, despite boost having a significant impact on local control in this group…”
Most patients who had salvage treatment for their first local failure had mastectomy (73.4%); 8.4% underwent tumorectomy, 5.5% none, and 12.7% “other.” Overall, however, the need for salvage mastectomy was 35% lower in the boost group than in the nonboost group. At 10, 15, and 20 years, the rates of salvage mastectomy were 6.4%, 9.0%, and 11.8%, respectively, in the nonboost group compared with 10.3%, 13.5%, and 16.9% in the boost group (HR, 0.65; P < .001).
The nonboost and boost groups did not differ for distant metastasis (21.4% vs 22.5%), second primary contralateral or homolateral breast cancer (7.8% vs 8.7% and 1.1% vs 0.8%, respectively) or second primary nonbreast cancer (8.4% vs 9.1%), including second primary lung cancer (11.6% vs 14.2%), said Dr. Bartelink.
And causes of death were similar in nonboost and boost patients for breast cancer (16.8% vs 17.1%), second cancer (3.3% vs 3.5%), and cardiovascular disease (2.4% vs 2.6%).
“In this large study with more than 5000 patients which was aimed to show that local control has an impact on survival, there is absolutely no difference at all in survival,” he concluded.
However, the rate of severe fibrosis was significantly higher in patients who received a boost (HR, 2.78; P < .0001). At 10, 15, and 20 years the rates were 4.3%, 4.8%, and 5.2%, respectively, in the boost group compared with 1.6%, 1.7%, and 1.8% in the nonboost group. “Fortunately the increase in fibrosis was less in young patients, while in this group the absolute increase in local control was the largest,” he told Medscape Medical News.
Dr. Bourgier, from the Institut Gustave Roussy, Villejuif, France, wrote a commentary after the publication of the trial’s 10-year results in which she pointed out that adverse events, such as severe fibrosis, are likely to have more impact on young patients…”
“Radiotherapy boost after whole-breast radiotherapy led to lower rates of ipsilateral breast tumor recurrence in patients with ductal carcinoma in situ, according to results of a retrospective study…
Moran and colleagues analyzed pooled, deidentified patient-level data from 4,131 patients (median age, 56.1 years; range, 24-88) with newly diagnosed DCIS from 10 academic institutions in the United States, Canada and France. Of these patients, 2,661 received a radiotherapy boost (median boost dose, 14 Gy) and 1,470 did not…
Median follow-up was 9 years…
Ipsilateral breast tumor recurrence events occurred in 253 patients (6.1%). Of these, 118 (46.6%) were invasive.
Rates of ipsilateral breast tumor RFS were 96.8% at 5 years, 93.6% at 10 years and 90.4% at 15 years.
Patients who received a radiotherapy boost demonstrated higher rates of ipsilateral breast tumor RFS than patients who did not receive a boost at
“In cancer, the length of time after primary treatment for a cancer ends that the patient survives without any signs or symptoms of that cancer. In a clinical trial, measuring the RFS is one way to see how well a new treatment works. Also called DFS, disease-free survival, and relapse-free survival.”