Originally published as JCO Early Release 10.1200/JCO.2007.12.7969 on February 4 2008

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Absolute Risk Reductions for Local Recurrence After Postoperative Radiotherapy After Sector Resection for Ductal Carcinoma In Situ of the Breast

Lars Holmberg, Hans Garmo, Bengt Granstrand, Anita Ringberg, Lars-Gunnar Arnesson, Kerstin Sandelin, Per Karlsson, Harald Anderson, Stefan Emdin

From the Department of Surgical Sciences and Regional Oncologic Center, Uppsala University Hospital, Uppsala; Department of Plastic and Reconstructive Surgery, University Hospital MAS, Malmö; Department of Surgery, University Hospital, Linköping; Department of Surgery, Karolinska University Hospital, Stockholm; Department of Oncology, Sahlgrenska University Hospital, Gothenburg; Department of Cancer Epidemiology, Lund University, Lund; Sweden Department of Surgery, Umeå University Hospital, Umeå, Sweden; and King's College London, Division of Cancer Studies, London, United Kingdom

Corresponding author: Lars Holmberg, MD, PhD, Division of Cancer Studies, Thomas Guy House, 3rd Floor, King's College London, Guy's Campus, London SE1 9RT, United Kingdom; e-mail: lars.holmberg{at}kcl.ac.uk

Purpose Evaluate the effects of radiotherapy after sector resection for ductal carcinoma in situ of the breast (DCIS) in patient groups as defined by age, size of the lesion, focality, completeness of excision and mode of detection.

Patients and Methods A total of 1,067 women in Sweden were randomly assigned to either postoperative radiotherapy (RT) or control from 1987 to 1999, and 1,046 were followed for a mean of 8 years. The main outcome was new ipsilateral breast cancer events and distant metastasis–free survival analyzed according to intention to treat.

Results There were 64 ipsilateral events in the RT arm and 141 in the control group corresponding to a risk reduction of 16.0 percentage points at 10 years (95% CI, 10.3% to 21.6%) and a relative risk of 0.40 (95% CI, 0.30 to 0.54). There was no statistically significant difference in distant metastasis–free survival. There was an effect modification by age, yielding a low effect of RT in women younger than 50, but substantial protection in women older than 60 years. The age effect was not confounded by focality, lesion size, completeness of excision, or detection mode. There was no group as defined by our stratification variables that had a low risk without radiotherapy.

Conclusion Our results indicate that younger women have a low protective effect of conventional RT after sector resection. Older women benefit substantially. We caution that the age effect was seen in a subgroup analysis. Further search with conventional clinical variables for a low risk group that does not need RT does not seem fruitful.

published online ahead of print at www.jco.org on February 4, 2008.

Supported by the Swedish Cancer Society. This study was governed by the Swedish Breast Cancer Group.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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