Following breast-conserving surgery (BCS) for localized ductal carcinoma in situ (DCIS) of the breast, whole-breast irradiation (WBRT) is a standard of care, reducing the absolute rate of in-breast recurrences (IBR) by more than 15% at 10 years, from 28% without radiotherapy to 13 % with radiotherapy. Half of the recurrences occurred as invasive disease. Whereas in the comparative trials, WBRT did not impact on overall survival, survival of patients who recurred with invasive cancers was impaired in comparison to patients who did not recur, or to patients with DCIS-only recurrences. Using criteria based on age, tumor size, nuclear grade, and margins status, several trials and cohort studies failed to identify subgroups of patients at low risk, who could be safely spared the need for WBRT. The Radiation Therapy Oncology Group (RTOG) DCIS trial included patients treated with BCS for low- or intermediate grade DCIS revealed by unifocal microcalcifications, size ≤25 mm, margins ≥3 mm, and no residual microcalcifications after surgery. The 5-year rates of IBR were 3.5 % without radiotherapy, versus 0.4 % with radiotherapy, and 6.7 % and 0.9 % at 7 years, respectively (p \<0.001). Sixty percent of the patients received tamoxifen in both groups. Several studies showed that the same molecular classes were identified in DCIS as in invasive cancers. Studies suggested that low proliferation, hormone receptors expression, and lack of ERBB2 amplification were associated with a low risk of IBR in patients not receiving radiotherapy. A combined signature was tested in the Eastern Cooperative Oncology Group (ECOG) trial, showing a 10% IBR rate at ten years in patients with a low-risk. Identifying very low-risk DCIS, using biological markers in addition to the clinical and histological markers of low-risk DCIS, could help to select patients who could be safely avoided WBRT following BCS. It would avoid over-treatment in these women and could decrease the cost of management.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
295
two fractionation regimens will be allowed for whole-breast irradiation: 50 Gy in 25 fractions over 5 weeks or 40 Gy in 15 fractions over 3 weeks. The delivery of an additional dose to the tumour bed (boost) will be at the referring physician discretion, according to the guidelines
No Irradiation- Active surveillance
Institut de Cancérologie de l'Ouest -Site Paul Papin
Angers, France
Institut Sainte Catherine
Avignon, France
Centre d'Oncologie et de Radiothérapie du Pays Basque
Bayonne, France
Clinique Belharra
Bayonne, France
Institut Bergonie
Bordeaux, France
Centre Francois Baclesse
5-year cumulative incidence of in-breast cancer recurrences
Incidence of breast recurrence is determined from the date of last surgery to the date of breast recurrence.
Time frame: 5 years
Overall survival (OS)
OS is defined as the interval between the date of last surgery and the date of death from any cause;
Time frame: 10 years
Breast cancer-specific survival (BCSS)
BCSS is defined as the interval between the date of last surgery and the date of death from breast cancer
Time frame: 10 years
Relapse-free survival (RFS)
RFS is defined as the interval between the date of last surgery and the date of ipsilateral breast recurrence, regional nodes recurrence, distant metastases, of death from breast cancer, whichever occurs first
Time frame: 10 years
Rate of in-breast recurrences (IBR).
In-breast recurrence defined as any carcinoma (invasive or in situ) occurring in the treated breast
Time frame: 10 years
Rate of Contralateral breast
Contralateral breast cancer defined as any carcinoma (invasive or in situ) occurring in the contralateral breast.
Time frame: 10 years
Quality of life of the patients using EORTC-QLQ-C 30
Quality of life will be assessed using QLQ-C 30 questionnaire from the European Organization for Research and Treatment of Cancer (EORTC). It is a 30-item self-reporting questionnaire developed to assess the quality of life of cancer patients. It is grouped into five functional subscales (role, physical, cognitive, emotional and social functioning). In addition, there are three multi-item symptom scales (fatigue, pain, and nausea and vomiting), individual questions concerning common symptoms in cancer patients,and two questions assessing overall Quality of Life
Time frame: 3 years
Quality of life of the patients using EORTC-QLQ-BR23
Quality of Life of Patients will be assessed using a EORTC-QLQ BR23.It is a 23-item self-reporting specific questionnaire developed to assess the quality of life of breast cancer patients. It permits to evaluate the symptoms of breast cancer and the side effects of treatment.
Time frame: 3 years
Cosmetics Evaluation
cosmetic results will be evaluated by centralized photographic analysis.
Time frame: 3 years
Long term toxicities
The National Cancer Institute-Common Terminology Criteria for Adverse Events version 5 (NCI-CTCAE v5) is widely accepted in the community of oncology research as the leading rating scale for adverse events. This scale, divided into 5 grades (1 = "mild", 2 = "moderate", 3 = "severe", 4 = "life-threatening", and 5 = "death") determined by the investigator, will make it possible to assess the severity of the disorders and so the late effects and sequelea regarding the whole-breast radiotherapy.
Time frame: Throughout study completion, up to 10 years.
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Caen, France
Centre Hospitalier du Cotentin
Cherbourg, France
Centre Jean Perrin
Clermont-Ferrand, France
CHIC Créteil
Créteil, France
Hôpital Henri Mondor
Créteil, France
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