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Topics:
Breast Cancer • Radiation Oncology • ASCO Journal Club • Breast Cancer, Non-metastatic • DCIS
How do you approach the decision to boost patients diagnosed with DCIS?
What factors do you consider?
Is your thought process at all different from your approach to boost with IDC?
Do you apply TROG 7.01 data (age <50 or at least one of: palpable tumor, multifocal disease, ≥1.5cm, G2-3, central necrosis, comedo histology, and margins <1cm) had improved 5-yr freedom-from-local-recurrence with the addition of boost?
For additional reading, see JCO OGR 11/2021 by @Laura Warren and @Jennifer R. Bellon reviewing landscape of adjuvant treatment after lumpectomy for DCIS, and companion study with longterm outcomes from RTOG 9804 (@Beryl McCormick et al).
Answer from: Radiation Oncologist at Community Practice
Great question! In general, patients fall within 3 scenarios regarding a DCIS boost.1. Clear Indications for boost. From the TROG data that you described and the ASTRO fractionation consensus, nearly everyone boosts "non-low risk" DCIS.Age <50 or age ≥50 + 1 RF (palpable tumor, multifocal dise...
Answer from: Radiation Oncologist at Academic Institution
BIG 3-07/TROG 07.01 (San Antonio Breast Cancer Symposium 2020, abstract GS2-04) is the only randomized prospective trial looking at the role of a boost in women with DCIS. This showed an absolute 4% improvement in 5-year local recurrence (93% to 97%; hazard ratio 0.47, 95% CI 0.31-0.72, p<0.001)....
Answer from: Radiation Oncologist at Academic Institution
All of the large prospective randomized trials for DCIS designed to compare local recurrence outcomes with radiation or no radiation, did not employ a boost in the trial design. So if I have a patient that meets all the “good risk” criteria for the RTOG 9804 trial, I do not prescribe a b...
Comments
Radiation Oncologist at Angelhaven LLC
An older study (Lalani et al., PMID 25220719 or Wi...
An older study (Lalani et al., PMID 25220719 or Wi...
@Sushil Beriwal - Thanks for the abstract. Like y...
I use hypofractionation so use 10 in 4. In the ab...