Investigating the effectiveness of adjuvant therapy for patients with hormone receptor-positive ductal carcinoma in situ

PLoS One. 2022 Jan 28;17(1):e0262934. doi: 10.1371/journal.pone.0262934. eCollection 2022.

Abstract

Background: This study compared the recurrence risk of single versus dual adjuvant radiotherapy (RT) and hormonal therapy (HT) following breast-conserving surgery (BCS) in patients with hormone receptor-positive ductal carcinoma in situ (DCIS).

Methods: This retrospective cohort study used the Taiwan Cancer Registry database linking to the Taiwan National Health Insurance data from 2011 to 2016. We compared the recurrence risk between BCS-based regimens in Cox regressions and presented as adjusted hazard ratio (HR) and 95% confidence interval (95%CI).

Results: The 1,836 study cohort with a low-to-intermediate risk of recurrence was grouped into BCS alone (6.1%), BCS+RT (6.2%), BCS+HT (23.4%) and BCS+HT+RT (64.3%) according to the initial treatments. During the follow-up (median: 3.3 years), the highest 5-year recurrence-free survival rate was in BCS+RT (94.1%) group and followed by BCS+HT+RT (92.8%), BCS+HT (87.4%) and BCS alone (84.9%). Of the single adjuvant therapies, RT was more effective than HT. Both BCS+HT (HR: 1.52, 95%CI: 0.99-2.35) and BCS+RT (HR: 1.10, 95%CI: 0.50-2.41) did not significantly increase recurrence risk comparing against the BCS+HT+RT group.

Conclusion: Single adjuvant demonstrated a similar subsequent recurrence risk with dual adjuvant. This study supports the proposition to de-escalate adjuvant treatments in patients with low-to-intermediate risk of DCIS recurrence.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Breast Neoplasms* / mortality
  • Breast Neoplasms* / therapy
  • Carcinoma, Ductal, Breast* / mortality
  • Carcinoma, Ductal, Breast* / therapy
  • Databases, Factual*
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Hormone Replacement Therapy
  • Humans
  • Middle Aged
  • Radiotherapy
  • Registries*
  • Retrospective Studies
  • Survival Rate
  • Taiwan / epidemiology

Grants and funding

KPH: Kaohsiung Medical University, Taiwan (Grant Number KMU-M104019) HYH: Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan (Grant Number KMUH109-M924). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.