Outcome of different radiotherapy strategies after breast conserving surgery in patients with ductal carcinoma in situ (DCIS)

Authors

  • Fredrik Wärnberg a Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; b Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
  • Charlotta Wadsten c Department of Surgery, Sundsvall Hospital, Umeå University, Umeå, Sweden
  • Andreas Karakatsanis d Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
  • Roger Olofsson Bagge a Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; b Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
  • Erik Holmberg e Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  • Henrik Lindman f Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
  • Elinor Sawyer g Guys Cancer centre, Kings College London, London, UK
  • Frank Vicini h Regional Oncologic Centre, NRG, Oncology, and 21st Century Oncology, Pontiac, MI, USA
  • G. Bruce Mann i Department of Surgery, The University of Melbourne, Melbourne, Australia
  • Per Karlsson e Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

DOI:

https://doi.org/10.1080/0284186X.2023.2245552

Keywords:

DCIS, radiotherapy, recurrence, outcome, cost

Abstract

Background

Adjuvant radiotherapy (RT) after breast-conserving surgery for DCIS lowers the relative local recurrence risk by half. To identify a low-risk group with the minimal benefit of RT could avoid side effects and spare costs. In this study, the outcome was compared for different RT-strategies using data from the randomized SweDCIS trial.

Material and methods

Five strategies were compared in a Swedish setting: RT-to-none or all, RT to high-risk women defined by DCISionRT, modified Radiation Therapy Oncology Group (RTOG) 9804 criteria, and Swedish Guidelines. Ten-year recurrence risks and cost including adjuvant RT and local recurrence treatment cost were calculated.

Results

The mean age at recurrence was 64.4 years (36–90) and the mean cost for treating a recurrence was $21,104. In the SweDCIS cohort (n = 504), 59 women developed DCIS, and 31 invasive recurrence. Ten-year absolute local recurrence risk (invasive and DCIS) according to different strategies varied between 18.6% (12.5–23.6%) and 7.8% (5.0–12.6%) for RT-to-none or to-all, with an additional cost of $2614 US dollars per women and $24,201 per prevented recurrence for RT-to-all. The risk differences between other strategies were not statistically significant, but the larger proportion receiving RT, the fewer recurrences. DCISionRT spared 48% from RT with 8.1% less recurrences compared to RT-to-none, and a cost of $10,534 per prevented recurrence with additional cost depending on the price of the test. RTOG 9804 spared 39% from RT, with 9.7% less recurrences, $9525 per prevented recurrence and Swedish Guidelines spared 13% from RT, with 10.0% less recurrences, and $21,521 per prevented recurrence.

Conclusion

It seems reasonable to omit RT in pre-specified low-risk groups with minimal effect on recurrence risk. Costs per prevented recurrence varied more than two-fold but which strategy that could be considered most cost-effective needs to be further evaluated, including the DCISionRT-test price.

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Published

2023-09-02

How to Cite

Wärnberg, F., Wadsten, C., Karakatsanis, A., Olofsson Bagge, R., Holmberg, E., Lindman, H., … Karlsson, P. (2023). Outcome of different radiotherapy strategies after breast conserving surgery in patients with ductal carcinoma in situ (DCIS). Acta Oncologica, 62(9), 1045–1051. https://doi.org/10.1080/0284186X.2023.2245552

Issue

Vol. 62 No. 9 (2023): Acta Oncologica

Section

Articles