Luc Vakaet
description
Transcript of Luc Vakaet
![Page 1: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/1.jpg)
Radiotherapy vs.No Radiotherapy
after breast conserving surgery (BCS)
for in-situ breast cancer.Luc Vakaet
![Page 2: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/2.jpg)
Clash of the titans
Bernard Fisher Melvin Silverstein
![Page 3: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/3.jpg)
EBCTCG: RT vs no RT for DCIS
Study Name Inclusion criteria Entry # pts Prescription Margins clear?
NSABP B-17 Lumpectomy 1985-1990 818 50 Gy to breast No
EORTC 10853 Local Excision; Age < 70
1986-1996 1010 50 Gy to breast No
Swedish DCIS Study
Quadrantectomy 1988 1046 50 Gy to breast No
Stockholm 8 Breast-Conserving Surgery
1990-1999 188 50 Gy to breast No
UK DCIS Trial Screen-Detected; Complete Local
Excision;
1990 1030 50 Gy to breast Yes
Total 4092
EBCTCG Preliminary results. Not for publication or
citation
![Page 4: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/4.jpg)
Results: Isolated local recurrenceRelative risk
event total ev/tot event total ev/tot
NSABP B-17 76 413 18% 138 405 34% 54%
EORTC 10853 72 507 14% 126 503 25% 57%
Swedish BCCG 42 526 8% 114 520 22% 36%
Stockholm 8 13 95 14% 25 93 27% 51%
UK DCIS 29 522 6% 69 508 14% 41%
Totals 232 2063 11% 472 2029 23% 48%
Radiation Control
![Page 5: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/5.jpg)
![Page 6: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/6.jpg)
Preliminary results. Not for publication or
citation
EBCTCG Preliminary results. Not for publication or
citation
![Page 7: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/7.jpg)
EBCTCG Preliminary results. Not for publication or
citation
![Page 8: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/8.jpg)
EBCTCG Preliminary results. Not for publication
or citation
![Page 9: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/9.jpg)
RT prevents only clinically unimportant non-invasive recurrences?
Age
At riskLocal
recurrence Percent At riskLocal
recurrence Percent
Non-invasve 403 51 13% 411 30 7%
Invasive 403 53 13% 411 17 4%
Lumpectomy Lumpectomy + RT
NSABP B-17 JCO 1998
![Page 10: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/10.jpg)
Can we select patients that would not or very little benefit from RT
• Does DCIS size matter?= > Only for DCIS > 5 cm
• Does patient age matter?= > Unnecessary for patients older than 70
• Does margin width matter?= > Margins more than 1 cm is OK
• Does differentiation matter?= > Only for patients with Grade 3
![Page 11: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/11.jpg)
Margin width < 1 cm
Silverstein et al. NEJM 1999
What about theVan Nuys Prognostic Index (VNPI)?
![Page 12: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/12.jpg)
Does DCIS size matter?
EBCTCG Preliminary results. Not for publication
or citation
![Page 13: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/13.jpg)
Does age matter?
NSABP B-17 JCO 1998
Age
At riskLocal
recurrence Percent At riskLocal
recurrence Percent
<50 137 36 26% 137 21 15%
50-59 115 33 29% 131 12 9%
>59 151 35 23% 143 14 10%
Lumpectomy Lumpectomy + RT
![Page 14: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/14.jpg)
UKNZL DCIS Study: Always re-excision when margins are positive
Lancet 2003
![Page 15: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/15.jpg)
EORTC 10 yrs FU of local recurrence
26%54%
25%37%
13%30%37%
24%43%
18%34%35%
JCO 2006
![Page 16: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/16.jpg)
JCO 2006
![Page 17: Luc Vakaet](https://reader035.fdocuments.net/reader035/viewer/2022062315/56815989550346895dc6c98d/html5/thumbnails/17.jpg)
Summary of the scientific evidence
• 10.6 % (p < 0.0001) absolute gain in any recurrence by year 10. 50% relative reduction of the risk of recurrence.
• no difference in breast cancer mortality or any death by year 10.
• The gain in recurrence is statistically significant in any subgroup analysed.
• There are no prospectively verified prognostic indices for local recurrence.
• We cannot (yet) define a subgroup of patients with sufficiently low risk to exclude radiation after BCS.