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DOI: 10.1055/a-2505-1682
Treatment and Outcome of Ductal Carcinoma in Situ for the German Federal States Berlin and Brandenburg in the Period 2007–2020
Duktales Carcinoma in situ: Behandlung und Outcome in den deutschen Bundesländern Berlin und Brandenburg für den Zeitraum 2007–2020
Abstract
Background
Ductal carcinoma in situ (DCIS) of the female breast is treated with surgery possibly followed by radiotherapy (RT) and/or adjuvant hormonal therapy despite their known long-term side effects. Since not every DCIS will progress into an invasive breast cancer (IBC), disease progression and de-escalation of treatment is an important topic of current research.
Methods
During 2007–2020, 3905 individuals with a DCIS diagnosis were reported to the cancer registry of Brandenburg and Berlin. We selected 3424 women who were cancer-free prior to DCIS diagnosis and without synchronous diagnoses of DCIS or ipsilateral IBC (iIBC). The objective was to describe changes over time in DCIS treatment and risk of developing iIBC by treatment.
Results
We observed decreasing proportions of mastectomy, breast-conserving surgery (BCS) with RT, and standard versus hypofractionated RT over time. During a median follow-up of 3.8 years, 105 women developed iIBC. Compared with BCS + RT with standard fractionation (54.9%, 1878/3424, 53 iIBC events), hazard ratios (HR) for ilBC were 0.72 (95% confidence interval [CI] 0.26, 1.99; 4 events) for BCS + hypofractionated RT, 0.70 (95% CI 0.33, 1.41; 11 events) for BCS alone, and 0.83 (95% CI 0.50, 1.37; 26 events) for mastectomy. Analyses were adjusted for DCIS size, grade, residual tumor status and ECOG score.
Conclusion
We observed a de-escalation of treatment over time, with fewer mastectomies, less RT, and more hypofractionation of RT. No substantial differences in risk of iIBC were observed between these treatments. There is a need to evaluate DCIS treatment de-escalation in larger cohorts with longer follow-up.
Zusammenfassung
Hintergrund
Ein duktales Carcinoma in situ (DCIS) wird zunächst chirurgisch behandelt, danach erfolgt möglicherweise eine Strahlentherapie und/oder eine adjuvante Hormontherapie trotz der bekannten Langzeitnebenwirkungen. Da aber nicht jedes DCIS sich zu einem invasiven Mammakarzinom weiterentwickelt, ist das Fortschreiten der Erkrankung sowie eine Deeskalation der Behandlung ein wichtiges Thema in der aktuellen Forschung.
Methoden
Zwischen 2007–2020 wurden 3905 mit DCIS diagnostizierte Personen dem Krebsregister der Länder Brandenburg und Berlin gemeldet. Insgesamt wurden 3424 Frauen, die vor der Diagnose mit DCIS krebsfrei waren und keine synchrone Diagnose von DCIS oder ipsilateralem invasiven Mammakarzinom hatten, in die Untersuchung aufgenommen. Das Ziel war, die Veränderungen der Behandlung von DCIS im Laufe der Zeit und das Risiko, ein ipsilaterales invasives Mammakarzinom zu entwickeln, zu beschreiben.
Ergebnisse
Im Verlauf der Zeit stellten wir einen prozentualen Rückgang an Mastektomien und brusterhaltenden Therapien (BET) mit Strahlentherapie bzw. fraktionierter Strahlentherapie fest. Nach einem mittleren Follow-up von 3,8 Jahren entwickelte sich ein ipsilaterales invasives Mammakarzinom bei 105 Frauen (Endpunkt). Die Hazard Ratios der verschiedenen Behandlungsmethoden für die Entwicklung eines ipsilateralen invasiven Mammakarzinoms wurden verglichen. Im Vergleich mit BET + Strahlentherapie mit regulärer Fraktionierung (54,9%, 1878/3424, 53 Ereignisse) betrugen die Hazard Ratios 0,72 (95%-Konfidenzintervall [KI] 0,26–1,99; 4 Ereignisse) für BET + hypofraktionierte Strahlentherapie, 0,70 (95%-KI 0,33–1,41; 11 Ereignisse) für BET allein und 0,83 (95%-KI 0,50–1,37; 26 Ereignisse) für Mastektomien. Die Analysen wurden adjustiert um die Risikofaktoren DCIS-Größe, Tumorgrad, Resektionsstatus und ECOG-Status.
Schlussfolgerung
Wir stellten eine Deeskalation der Behandlung im Laufe der Zeit fest, mit weniger Mastektomien, weniger regulären Strahlentherapien und mehr hypofraktionierten Strahlentherapien. Es gab keine signifikanten Unterschiede zwischen den verschiedenen Behandlungen für das Risiko, ein ipsilaterales invasives Mammakarzinom zu entwickeln. Diese Deeskalation in der Behandlung von DCIS sollte in einem größeren Patientinnenkollektiv mit einem längeren Follow-up evaluiert werden.
Publication History
Received: 16 July 2024
Accepted after revision: 15 December 2024
Article published online:
30 January 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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