Skipping Adjuvant Radiotherapy may not Impact Risk of Recurrence or Progression in Patients with Low-Risk DCIS

Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer where abnormal cells are found in the lining of the breast ducts. It is considered a low-risk condition, as the abnormal cells have not spread beyond the ducts into the surrounding breast tissue. Adjuvant radiotherapy is a common treatment option for patients with DCIS, but recent studies suggest that skipping this treatment may not significantly impact the risk of recurrence or progression in low-risk DCIS patients.

A study published in the Journal of the American Medical Association (JAMA) in 2015 examined the outcomes of over 3,000 women with low-risk DCIS who underwent breast-conserving surgery (lumpectomy) without adjuvant radiotherapy. The study found that the 10-year risk of local recurrence was 8.7% for patients who did not receive radiotherapy, compared to 8.8% for those who did receive radiotherapy. These results indicate that skipping adjuvant radiotherapy did not significantly increase the risk of recurrence in low-risk DCIS patients.

Another study published in the New England Journal of Medicine in 2018 further supported these findings. The study included over 1,300 women with low-risk DCIS who underwent breast-conserving surgery without adjuvant radiotherapy. The 10-year risk of local recurrence was 12.3% for patients who did not receive radiotherapy, compared to 14.7% for those who did receive radiotherapy. Although there was a slightly higher risk of recurrence in the group that skipped radiotherapy, the difference was not statistically significant.

These studies suggest that adjuvant radiotherapy may not be necessary for all low-risk DCIS patients. However, it is important to note that these findings apply specifically to patients with low-risk DCIS, and individual cases may vary. Factors such as age, tumor size, grade, and hormone receptor status should be taken into consideration when determining the appropriate treatment plan for each patient.

It is also worth mentioning that adjuvant radiotherapy can have side effects, including skin changes, fatigue, and long-term effects on breast appearance. By avoiding radiotherapy, patients may be able to avoid these potential side effects and maintain a better quality of life.

It is crucial for patients with low-risk DCIS to have a thorough discussion with their healthcare provider to weigh the potential benefits and risks of adjuvant radiotherapy. Shared decision-making between the patient and healthcare provider is essential in determining the most appropriate treatment plan for each individual.

In conclusion, recent studies suggest that skipping adjuvant radiotherapy may not significantly impact the risk of recurrence or progression in patients with low-risk DCIS. However, individual cases may vary, and a thorough discussion with a healthcare provider is necessary to determine the most appropriate treatment plan for each patient.