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Breast Cancer Research and Treatment

, Volume 178, Issue 1, pp 105–113 | Cite as

Survival benefit of postoperative radiotherapy for ductal carcinoma in situ after breast-conserving surgery: a Korean population-based cohort study

  • Byoung Hyuck Kim
  • Byung Kyun Ko
  • Jeoung Won Bae
  • Seokjin Nam
  • Min Ho Park
  • Joon Jeong
  • Hyouk Jin Lee
  • Ji Hyun Chang
  • Suzy Kim
  • Ki-Tae HwangEmail author
Clinical Trial

Abstract

Purpose

It has been accepted that radiation therapy (RT) for ductal carcinoma in situ (DCIS) has no survival benefit despite increasing local control. However, a recent large database study reported a small but significant benefit. Using a Korean population-based large database, we examined the survival benefit of RT for DCIS after breast-conserving surgery (BCS) and analyzed which subgroup might derive benefit from it.

Methods

Data from 6038 female DCIS patients who underwent BCS with or without RT between 1993 and 2012 were included in this study. We used propensity score analysis to control for differences in baseline characteristics.

Results

Before adjusting, patients who received RT were more likely to have a large-sized tumor, poor histologic grade, poor nuclear grade, and less hormone receptor positivity. Ten-year overall survival (OS) rates were 95.0% in the non-RT group and 97.1% in the RT group (p < 0.001). After adjusting, previously noted differences of characteristics were substantially reduced, and then ten-year OS rates were 94.3% in the non-RT group and 97.6% in the RT group (p = 0.001). When examining the benefit of RT according to proposed prognostic scores, patients with a score of 0 showed no difference in OS by adding RT after BCS, whereas those with high scores demonstrated a significant benefit.

Conclusions

We demonstrated the significant OS benefit of postoperative RT after BCS based on a large database, and for the first time beyond the western population. The omission of RT for selected patients to prevent overtreatment needs to be more elaborately studied.

Keywords

Postoperative radiotherapy Ductal carcinoma in situ Breast-conserving surgery 

Notes

Acknowledgements

This article was supported by the Korean Breast Cancer Society (WA35-20170205-01).

Funding

The research for this manuscript was not financially supported and none of the authors had any relevant financial relationships.

Compliance with ethical standards

Conflict of interest

The authors declare that no actual or potential conflict of interest exists. The Institutional Review Boards approved this study (Seoul Metropolitan Government Seoul National University Boramae Medical Center, 07-2017-6).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Supplementary material

10549_2019_5372_MOESM1_ESM.docx (423 kb)
Supplementary material 1 (DOCX 423 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologySeoul Metropolitan Government Seoul National University Boramae Medical CenterSeoulRepublic of Korea
  2. 2.Department of Surgery, Ulsan University HospitalUniversity of Ulsan College of MedicineUlsanRepublic of Korea
  3. 3.Department of SurgeryKorea University Anam HospitalSeoulRepublic of Korea
  4. 4.Department of Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  5. 5.Department of SurgeryChonnam National University Medical SchoolKwangjuRepublic of Korea
  6. 6.Department of Surgery, Gangnam Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
  7. 7.Breast and Thyroid ClinicSegyero HospitalPusanRepublic of Korea
  8. 8.Department of SurgerySeoul Metropolitan Government Seoul National University Boramae Medical CenterSeoulRepublic of Korea

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