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• W2247241967 abstract "577 Background: The benefit of adding radiation therapy (RT) after excision of noninvasive carcinoma of the breast or ductal carcinoma in situ (DCIS) is widely debated. The management of DCIS was identified as one of the highest-priority topics in the Institute of Medicine's list of areas in need of comparative effectiveness research. Methods: Using available data about the events following recurrence, we created a Markov model to compare two different treatment choices in patients with DCIS, excision alone versus excision plus RT, to uncover the magnitude of potential benefits and disadvantages of each strategy. Risk of recurrence for each arm was derived from the EORTC randomized trial. The model was run for 3 age cohorts: 45, 60, 75 years of age at diagnosis. Variables potentially able to affect model results including risks of recurrence were studied in sensitivity analyses. Results: In all age groups, RT for DCIS was associated with a slight improvement in invasive disease-free, disease-free, and overall survival (Table). However, RT decreased the chance of having both breasts intact over a patient's lifetime. On average, we calculated that RT improved invasive disease-free survival by 18.5 months for a 45-year-old woman but decreased her chance of having both breasts by 11.3%. The differences in outcomes between the treatment strategies became smaller with increasing age at diagnosis. Sensitivity analyses revealed model results to be robust over a wide range of values for key parameters. Conclusions: Our analysis reveals that while RT increases invasive disease-free, disease-free, and overall survival, the magnitude of these benefits is quite modest, especially in older women. RT also increases the likelihood of eventual mastectomy. Patient age and preferences should therefore be considered when deciding to add or forgo RT for DCIS. Age 45 years 60 years 75 years Treatment RT No RT RT No RT RT No RT Invasive disease-free survival (months) 359.1 340.6 245.1 233.4 137.5 132.0 Disease-free survival (months) 309.2 275.0 219.4 197.1 127.9 117.3 Survival (months) 430.8 426.8 280.0 277.9 149.7 149.0 Percentage with both breasts at death (%) 63.5 74.8 73.5 82.0 83.5 88.8 No significant financial relationships to disclose." @default.
• W2247241967 created "2016-06-24" @default.
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• W2247241967 date "2010-05-20" @default.
• W2247241967 modified "2023-09-25" @default.
• W2247241967 title "Decision analysis: Excision alone versus excision plus radiation therapy for ductal carcinoma in situ." @default.
• W2247241967 doi "https://doi.org/10.1200/jco.2010.28.15_suppl.577" @default.
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