How do you approach the decision to boost patients diagnosed with DCIS?

Based on prospective and also retrospective data Chua, AACR Volume 81, Issue 4 Supplement, pp. GS2-04.

We would recommend for high grade, < 50 years and close margin and in the era of genomic testing to patients with high genomic score.

Great question! In general, patients fall within 3 scenarios regarding a DCIS boost.

1. Clear Indications for boost.
From the TROG data that you described and the ASTRO fractionation consensus, nearly everyone boosts "non-low risk" DCIS.
Age <50 or age ≥50 + 1 RF (palpable tumor, multifocal disease, t...

BIG 3-07/TROG 07.01 (San Antonio Breast Cancer Symposium 2020, abstract GS2-04) is the only randomized prospective trial looking at the role of a boost in women with DCIS. This showed an absolute 4% improvement in 5-year local recurrence (93% to 97%; hazard ratio 0.47, 95% CI 0.31-0.72, p<0.001). We...

All of the large prospective randomized trials for DCIS designed to compare local recurrence outcomes with radiation or no radiation, did not employ a boost in the trial design. So if I have a patient that meets all the “good risk” criteria for the RTOG 9804 trial, I do not prescribe a boost for tha...