Meta-analysis of trials of radiotherapy in DCIS Early Breast Cancer Trialists’ Collaborative Group (EBCTCG)

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Presentation transcript:

Meta-analysis of trials of radiotherapy in DCIS Early Breast Cancer Trialists’ Collaborative Group (EBCTCG)

Many MODERATE gains in long-term survival have been identified The world’s breast cancer trialists have shared their data every 5 years 1985, 1990, 1995, 2000, 2005/6 Many MODERATE gains in long-term survival have been identified Together MODERATE gains from various treatment improvements (and a moderate contribution from breast screening) have almost halved UK/US breast cancer mortality at ages 35-69 EBCTCG 5th Cycle

# EBCTCG 5th Cycle

EBCTCG 5th Cycle

EBCTCG 5th Cycle Trials starting before 1 Jan 2000 Events up to 30 Sept 2006 Included trials of BCS±RT in DCIS for the first time ie, trials of RT versus the same management but without RT EBCTCG 5th Cycle

EBCTCG 5th Cycle

EBCTCG 5th Cycle

EBCTCG 5th Cycle

Main outcome analysed: Ipsilateral breast recurrence (either recurrence of CIS or occurrence of invasive cancer) EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) 3729 women EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Ratio of annual event rates by patient and tumour characteristics

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Age at diagnosis EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Extent of breast-conserving surgery EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Use of tamoxifen (in both treatment arms) EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Method of DCIS detection EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Margin status EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Focality EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Histological grade EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Nuclear grade EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Comedonecrosis EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Architecture EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Clinical primary tumour size EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Pathological primary tumour size EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) among women with 1-20 mm tumours and negative margin status EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Ratio of annual event rates by age and histological grade

DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv) Ratio of annual event rates by age and comedonecrosis EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS 3729 women Contralateral breast events Regional or distant events EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS 3729 women Any breast event * *ie ipsilateral or contralateral DCIS, ipsilateral or contralateral invasive cancer, regional or distant metastasis, or death certified as due to breast cancer EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS 3729 women Mortality with a breast event Mortality without a breast event Mortality from all causes EBCTCG 5th Cycle

DCIS: BCS + RT vs. BCS 3729 women Heart disease mortality Non-breast primary cancer incidence EBCTCG 5th Cycle

EBCTCG analysis of radiotherapy in DCIS Conclusions In these trials, radiotherapy halved the recurrence rate of either DCIS or invasive cancer in the ipsilateral breast. After 5 years the absolute gain was about 10% (18% vs. 8%) and after 10 years it was about 15% (28% vs. 13%). The absolute gain in ‘low risk’ women was as large as in other other women. The proportional reduction in the ipsilateral recurrence rate was greater in women aged 50+ years than in younger women. Radiotherapy had no significant effect on mortality from breast cancer, at least to year 10. In these data, radiotherapy had no significant adverse effect on cancers other than breast cancer, or on mortality from non-breast cancer causes, including heart disease. EBCTCG 5th Cycle