Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ Journal Article


Authors: Shurell, E.; Olcese, C.; Patil, S.; McCormick, B.; Van Zee, K. J.; Pilewskie, M. L.
Article Title: Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ
Abstract: BACKGROUND: The current study was conducted to examine the association between ipsilateral breast tumor recurrence (IBTR) and the timing of radiotherapy (RT) in women with ductal carcinoma in situ (DCIS) undergoing breast-conserving surgery (BCS). METHODS: Women with DCIS who were treated with BCS and RT from 1980 through 2010 were identified from a prospectively maintained database. IBTR rates, measured from the time of RT completion, were compared between those who initiated RT ≤8 weeks, >8 to 12 weeks, and >12 weeks after the completion of surgery. The association between RT timing and IBTR was evaluated by Kaplan-Meier and log-rank analyses; Cox modeling was used for multivariable analysis. RESULTS: A total of 1323 women met the inclusion criteria. The median follow-up was 6.6 years, with 311 patients followed for ≥10 years. A total of 126 IBTR events occurred. Patients were categorized by RT timing: 806 patients (61%) with timing of ≤8 weeks, 386 patients (29%) with timing of >8 to 12 weeks, and 131 patients (10%) with timing >12 weeks. The 5-year and 10-year IBTR rates were 5.8% and 13.0%, respectively, for RT starting ≤8 weeks after surgery; 3.8% and 7.6%, respectively, for RT starting >8 to 12 weeks after surgery; and 8.8% and 23.0%, respectively, for an RT delay >12 weeks after surgery (P =.004). On multivariable analysis, menopause (hazard ratio [HR], 0.54; P =.0009) and endocrine therapy (HR, 0.45; P =.002) were found to be protective against IBTR, whereas a delay in RT >12 weeks compared with ≤8 weeks was associated with a higher risk of IBTR (HR, 1.92; P =.014). There was no difference in IBTR noted between RT initiation at ≤8 weeks and initiation at >8 to 12 weeks after BCS (P =.3). CONCLUSIONS: A delay in RT >12 weeks is associated with a significantly higher risk of IBTR in women undergoing BCS for DCIS. Efforts should be made to avoid delays in starting RT to minimize the risk of disease recurrence. Cancer 2018;124:46-54. © 2017 American Cancer Society. © 2017 American Cancer Society
Keywords: adult; controlled study; human tissue; aged; aged, 80 and over; disease-free survival; middle aged; human cell; major clinical study; histopathology; cancer recurrence; postoperative period; cancer radiotherapy; disease free survival; chemotherapy, adjuvant; radiotherapy, adjuvant; follow up; disease association; neoplasm recurrence, local; breast cancer; proportional hazards models; radiotherapy; risk factors; recurrence; breast neoplasms; risk factor; high risk patient; proportional hazards model; tumor recurrence; adjuvant chemotherapy; breast tumor; partial mastectomy; therapy delay; multivariate analysis; hormonal therapy; antineoplastic agents, hormonal; epidemiology; menopause; factual database; databases, factual; adjuvant radiotherapy; intraductal carcinoma; antineoplastic hormone agonists and antagonists; carcinoma, intraductal, noninfiltrating; mastectomy, segmental; ductal carcinoma in situ; protection; procedures; time to treatment; very elderly; protective factors; time-to-treatment; humans; human; female; priority journal; article; statistics and numerical data
Journal Title: Cancer
Volume: 124
Issue: 1
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2018-01-01
Start Page: 46
End Page: 54
Language: English
DOI: 10.1002/cncr.30972
PUBMED: 28960259
PROVIDER: scopus
PMCID: PMC5734990
DOI/URL:
Notes: Article -- Export Date: 2 January 2018 -- Source: Scopus
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MSK Authors
  1. Sujata Patil
    383 Patil
  2. Kimberly J Van Zee
    241 Van Zee
  3. Beryl McCormick
    243 McCormick
  4. Cristina Olcese
    20 Olcese