Quality of life after breast-conserving surgery for women with non-low-risk ductal carcinoma in situ
Mené sur 1 208 patientes atteintes d'un carcinome canalaire in situ, cet essai international de phase III évalue l'effet d'un traitement chirurgical conservateur et d'une radiothérapie de l'ensemble du sein sur la qualité de vie à 2 ans des patientes (résultats esthétiques, degré de fatigue, préservation des fonctions physiques, sexualité et image corporelle)
Formalised data collection on patient-reported outcomes (PROs) following treatment of early-stage breast cancer is now embedded in oncoplastic and reconstructive breast surgery. Most PRO studies to date pertain to invasive disease, which is likely to require adjuvant treatments that can adversely influence health-related quality of life (HRQOL). There is a dearth of information specifically relating to PROs for ductal carcinoma in situ, which has an exceptionally low mortality (3% at 20 years). There is no demonstrable survival benefit from the addition of breast irradiation, endocrine therapy, or a combination of these treatments, to lumpectomy. Breast irradiation proportionately halves the risk of ipsilateral breast recurrence, with an absolute reduction of 15·2% (p<0·00001) at 10 years reported in a meta-analysis. A low event rate might preclude any reduction in mortality from breast cancer or all-cause mortality. Any benefits of adjuvant therapies on local control must be balanced against potentially harmful side-effects plus patient inconvenience and cost. Contemporary guidelines recommend radiotherapy for most patients with non-low-risk ductal carcinoma in situ, but boost criteria remain uncer. Historically, trials of conservation therapy for ductal carcinoma in situ used a conventional radiotherapy schedule (50 Gy, 25 fractions, over 5 weeks) with a discretionary tumour bed boost for 5% and 9% of patients in two trials (based on factors such as young age and margin status).
The Lancet Oncology , commentaire, 2019