Try the all-new QuickBooks Online for FREE.  No credit card required.

Dear Dr

Document Sample
Dear Dr Powered By Docstoc
Jeanne-Marie Phillips                          Sharon Grutman
HealthFlash Marketing                          The American Society of Breast Surgeons
203-977-3333                                   877-992-5470   

New Study Finds Radiation Significantly Effects Recurrence Patterns in
DCIS Patients

Abstract: Difference in Recurrence Patterns by Treatment in Patients with DCIS

April 29, 2011, Washington--Radiation therapy benefits many but not all women with
DCIS (ductal carcinoma in situ) and patients should be followed up for an extended time
period, suggests a study presented this week at the American Society of Breast
Surgeons (ASBrS) annual meeting. Researchers at Hoag Memorial Hospital
Presbyterian in Newport Beach, CA found that while women treated with radiation
following breast-conserving surgery had a significantly lower recurrence rate, radiated
patients experienced more invasive recurrences and had a longer time from initial
diagnosis to recurrence.
       “This is the first study to focus on the pattern of recurrence in DCIS patients
treated with lumpectomy,” said investigator Janie Weng Grumley, M.D. “Radiation
therapy accompanying wide local excision (lumpectomy) of DCIS is known to reduce
local cancer recurrence by 50 percent. But when the cancer does come back, perhaps
surprisingly, we found major differences in the recurrence pattern between patients who
did and did not receive radiation. As more patients opt for breast conserving therapy
without radiation, a clear understanding of the differences in the pattern of recurrence
will be important.”
       Noting that DCIS is an early and highly curable form of cancer, Dr. Grumley
explains that these tumors are most often treated by excising only the diseased portion
of the breast. Surgery may be accompanied by radiation treatment to kill any cancer
cells that remain.
        This prospective 10-year study followed 1,000 patients with pure DCIS who
underwent breast-conserving surgery with or without radiation. It found that radiated
patients took about twice as long to recur as those who did not receive the therapy and
had a higher percentage of invasive recurrences. This resulted in a small but statistically
significant lower breast cancer survival rate.
        “For patients not treated with radiation, our research found that four years was
the average time to recurrence for a DCIS lesion in the same area of the breast,” she
said. “However, for radiated patients, a similar recurrence did not develop for about six
years. The average time to recurrence overall for patients not receiving radiation was
just under four years. For those receiving radiation, it was almost eight years.”
        In addition, 28 percent of radiated patients who did recur experienced tumors in
different quadrants of the breast than their initial disease—constituting new primary
cancers. Only 10 percent of patients who did not receive radiation eventually developed
tumors in different quadrants.
        “Overall, far fewer patients receiving radiation for DCIS have cancer recurrences.
However, this study shows that given current protocols for treatment and follow up, a
small sub-group of radiated DCIS patients may not be deriving maximum benefit from
radiation therapy or not benefiting from it at all. It also demonstrates that for a
statistically significant number of these women, a five-year cancer-free status is not a
        Noting a range of possible explanations for these findings, Grumley says this
study clearly highlights the importance of close ongoing follow up of radiated DCIS
patients because DCIS is a complex and multi-faceted disease.
        “As we continue to diagnose more cancer at an earlier stage, research must
examine which patients are more likely to benefit from radiation based on such factors
as lesion size and grade and patient age,” said Grumley. “This study highlights the need
to pinpoint women who will derive the maximum benefit from radiation for the minimum
risk to personalize care.”

(Abstract Follows)
Abstract 1642: Difference in Recurrence Patterns by Treatment in Patients with

Janie Weng Grumley, Michael D. Lagios, Jesicca Rayhanabad, Stephanie Valente,
Melvin J. Silverstein
Breast Service, Hoag Memorial Hospital Presbyterian, Newport Beach, CA and Division
of Breast and Soft Tissue Surgery, Department of Surgery, University of Southern
California, Los Angeles, CA
Background: Ductal carcinoma in situ (DCIS) is commonly treated using wide local
excision with or without postoperative radiation therapy. Radiation therapy is known to
reduce the local recurrence rate by a relative 50%. We were interested in whether the
pattern of local recurrence (invasive versus noninvasive, quadrant of recurrence, time to
recurrence) and breast cancer specific survival changed with the addition of radiation
Methods: Using a prospective database, 1014 patients with pure DCIS who underwent
breast conserving surgery were analyzed for type of local recurrence (invasive versus
DCIS), median time to recurrence, quadrant of recurrence (same or different) and breast
cancer specific survival. Probabilities of local recurrence were derived using the Kaplan-
Meier Method. Probabilities were compared using the Log-rank test.
Results: Radiated patients had a significantly lower 10-year probability of recurrence but
a higher rate of invasive recurrences, longer time to diagnosis of recurrence and a slightly
lower but significant 10-year breast cancer specific survival when compared to patients
not treated with radiation.

                                                   Excision plus
                          Excision Alone         Radiation Therapy
                             (N=651)                   (N=363)                 P Value

Average Follow-up              72 mo                   109 mo                  <0.001

10-yr Probability
Any Local
Recurrance                     30%                       18%                   0.0102

% Invasive Local
Recurrence                     37%                       57%                    0.009

10-yr Prob Invasive
Local Recurrence               14%                       10%                     0.55

Mean time to any
local recurrence               53mo                     90 mo                  <0.001

Mean time local                49 mo                    67 mo                    0.04
recurrence same

Mean time local
recurrence different
quadrant                       82 mo                   151 mo                    0.01

# Recurrences same
quadrant                  104/115 (90%)              48/67 (72%)               0.0016

Mean time to DCIS
recurrence                     41 mo                    73 mo                   0.002

Mean time to
Invasive recurrence            72 mo                   105 mo                   0.017

Breast Cancer
Specific Survival             99.7%                     98.3%                    0.02

Conclusions: Our data confirm an approximate 50% reduction in local recurrence if
radiation therapy is given and are consistent with the published prospective randomized
data. But the pattern of recurrence in irradiated patients differs significantly from
excision only patients. 28% of post irradiation recurrences were in different quadrants, in
essence, new cancers, compared with only 10% for excision only patients. Irradiated
patients who recurred took longer to recur. This was true for both invasive and DCIS
recurrences. When irradiated patients recurred, they had a higher percentage of invasive
recurrences. This resulted in a statistically significant lower 10-yr breast cancer specific

Shared By: