Radiotherapy of the whole breast followed by a boost could stop the very early stages of breast cancer from returning claim researchers from the international Rare Cancer Network in paper published online today by The Lancet Oncology. This strategy should therefore be considered in addition to surgery for patients with the breast-cancer precursor called ductal carcinoma in situ, or DCIS.
We had two main findings notes Guenther Gruber (Kantonsspital, Aarau, Switzerland), lead author of the study: "First, not using radiotherapy in young patients with DCIS resulted in an unacceptable number of women having their cancer return; and second, these patients benefit from an additional boost dose".
Boost radiotherapy, in which a "boost" of 10–16 Gy of radiotherapy is given in addition to the normal radiotherapy treatment after surgery, is already known to work in invasive breast cancer, and especially so in younger women. The researchers therefore decided to try out this technique in younger women, but with DCIS, an earlier stage of breast cancer.
Dr Gruber and colleagues analysed the records of 373 women aged 45 years or younger from 18 institutions throughout the world who had DCIS and had received breast-conserving surgery. About a sixth of the patients were not given any radiotherapy after surgery; almost half received radiotherapy without a boost; and the remaining two-fifths received radiotherapy with an extra boost. The researchers found that the risk of the cancer returning decreased progressively for each of these techniques – the most effective was radiotherapy with a boost.
So far, no randomised trials, the gold standard of assessment, have been done to assess the effects of boost radiotherapy in young women with DCIS. Dr Gruber therefore suggests that their results might mean that this technique will now be considered as a part of the armamentarium of breast conserving treatment, until randomised studies are done. "Of course", he adds, "radiotherapy has to be applied carefully, especially in regard to heart, lungs and the other breast".
Dr Guenther Gruber
5001 Aarau, Switzerland.
T) 41-62-838-5378. firstname.lastname@example.org
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