How do you approach the discussion of omission vs. inclusion of adjuvant radiation in patients with low to intermediate-grade DCIS?  

There are several factors when evaluating patients with low/intermediate grade DCIS and the role of RT: Estrogen negative. While rare, I almost always recommend RT. Willingness to take endocrine therapy. More and more patients are concerned about taking endocrine therapy and I discuss RT in these ...

I find that most patients can understand the concept of local recurrence risk of “1% per year of follow-up from diagnosis” without radiation. I usually present this information first. I then add that radiation had a significant impact on that local recurrence, with the 10-year rate of fa...

Our guidance and approach to DCIS at MSKCC is a joint guidance developed by rad onc and surgery. We developed this to try to make our approach uniform across the network. Notably, we acknowledge that outside of the absolute indications, there is a lot of unstructured decision-making based on patient...

We typically start this discussion with a general review of the pathophysiology and natural history of DCIS. We explain that radiation has not been shown in a prospective randomized trial to impact overall survival; as such, patient preference is paramount to decision-making. Based on the low-risk c...

For almost all patients, I explain that there is a local control benefit (2/3 reduction based on RTOG 9804, etc., which ends up being ~10% absolute reduction for most) but probably no survival benefit. My strength of recommendation would depend on age, size, margin, etc. but I always tell patients t...

I wouldn’t. If it’s worth operating, it’s worth irradiating. RT is likely less risky than anesthesia, particularly, for an older patient.

I plead stupidity. As several of you cite data that many recurrences continue in years 10-15 after treatment and well beyond year 15, how can you accept APBI trials or those with hypofractionation, none of which have reached the minimum follow-up that surgeons demanded in the 1980s for accepting lu...