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Impact of Radiotherapy on DCIS in Early Breast Cancer: Meta-Analysis of Trials by EBCTCG

Analysis of trials conducted by the EBCTCG every 5 years from 1985 to 2005/6, exploring the impact of radiotherapy on long-term survival and breast cancer mortality in women with DCIS. Results show a significant reduction in ipsilateral breast recurrence rates with radiotherapy, while mortality from breast cancer remains unaffected. No adverse effects on non-breast cancer or heart disease mortality were observed.

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Impact of Radiotherapy on DCIS in Early Breast Cancer: Meta-Analysis of Trials by EBCTCG

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  1. Meta-analysis of trials of radiotherapy in DCIS Early Breast Cancer Trialists’ Collaborative Group (EBCTCG)

  2. The world’s breast cancer trialists have shared their data every 5 years 1985, 1990, 1995, 2000, 2005/6 Many MODERATE gains in long-term survival have been identified Together MODERATE gains from various treatment improvements (and a moderate contribution from breast screening) have almost halved UK/US breast cancer mortality at ages 35-69 EBCTCG 5th Cycle

  3. # EBCTCG 5th Cycle

  4. EBCTCG 5th Cycle

  5. EBCTCG 5th Cycle • Trials starting before 1 Jan 2000 • Events up to 30 Sept 2006 • Included trials of BCS±RT in DCIS for the first time • ie, trials of RT versus the same management but without RT EBCTCG 5th Cycle

  6. EBCTCG 5th Cycle

  7. EBCTCG 5th Cycle

  8. EBCTCG 5th Cycle

  9. Main outcome analysed: • Ipsilateral breast recurrence (either recurrence of CIS or occurrence of invasive cancer) EBCTCG 5th Cycle

  10. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) EBCTCG 5th Cycle

  11. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) 3729 women EBCTCG 5th Cycle

  12. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Ratio of annual event rates by patient and tumour characteristics

  13. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Age at diagnosis EBCTCG 5th Cycle

  14. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Extent of breast-conserving surgery EBCTCG 5th Cycle

  15. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Use of tamoxifen (in both treatment arms) EBCTCG 5th Cycle

  16. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Method of DCIS detection EBCTCG 5th Cycle

  17. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Margin status EBCTCG 5th Cycle

  18. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Focality EBCTCG 5th Cycle

  19. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Histological grade EBCTCG 5th Cycle

  20. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Nuclear grade EBCTCG 5th Cycle

  21. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Comedonecrosis EBCTCG 5th Cycle

  22. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Architecture EBCTCG 5th Cycle

  23. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Clinical primary tumour size EBCTCG 5th Cycle

  24. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Pathological primary tumour size EBCTCG 5th Cycle

  25. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) • among women with 1-20 mm tumoursand negative margin status EBCTCG 5th Cycle

  26. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Ratio of annual event rates by age and histological grade

  27. DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv) Ratio of annual event rates by age and comedonecrosis EBCTCG 5th Cycle

  28. DCIS: BCS + RT vs. BCS3729 women • Contralateral breast events Regional or distant events EBCTCG 5th Cycle

  29. DCIS: BCS + RT vs. BCS3729 women • Any breast event * • *ie ipsilateral or contralateral DCIS, ipsilateral or contralateral invasive cancer, • regional or distant metastasis, or death certified as due to breast cancer EBCTCG 5th Cycle

  30. DCIS: BCS + RT vs. BCS3729 women • Mortality with a breast event Mortality without a breast event Mortality from all causes EBCTCG 5th Cycle

  31. DCIS: BCS + RT vs. BCS3729 women • Heart disease mortality Non-breast primary cancer incidence EBCTCG 5th Cycle

  32. EBCTCG analysis of radiotherapy in DCISConclusions • In these trials, radiotherapy halved the recurrence rate of either DCIS or invasive cancer in the ipsilateral breast. After 5 years the absolute gain was about 10% (18% vs. 8%) and after 10 years it was about 15% (28% vs. 13%). • The absolute gain in ‘low risk’ women was as large as in other other women. • The proportional reduction in the ipsilateral recurrence rate was greater in women aged 50+ years than in younger women. • Radiotherapy had no significant effect on mortality from breast cancer, at least to year 10. • In these data, radiotherapy had no significant adverse effect on cancers other than breast cancer, or on mortality from non-breast cancer causes, including heart disease. EBCTCG 5th Cycle

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