How does the potential for a patient to accept or forego adjuvant tamoxifen factor into your recommendations on adjuvant RT for DCIS?

In the RTOG 9804 trial, the only factors predicting for local control in the breast were the use of radiation and of tamoxifen. So for women who have hormone positive tumors, I strongly advocate for some treatment in addition to the lumpectomy.

I find the results of the UK, Australia, and New Zealand DCIS trials particularly helpful when discussing tamoxifen use with patients. That trial used a 2 X 2 factorial design, resulting in four cohorts of patients, those who received only breast radiation, those who received only tamoxifen, those who received both, and those who had surgery only. Analyzing only the women assigned to radiation, the study found almost no evidence that the addition of tamoxifen resulted in better ipsilateral breast loca...

For patients with ER+ DCIS, Tamoxifen has been shown to reduce the risk of ipsilateral and contralateral breast cancer (Allred et al., PMID 22393101). However, like adjuvant radiation, there is no significant survival benefit. Given the relatively modest benefit of adjuvant Tamoxifen on local control (Cuzick et al., PMID 21145284) (or aromatase inhibitors in post-menopausal women based on the data from NSABP B-35 Margolese et al., PMID 26686957) and the potential side effects, the decision to proceed with adjuvant endocrine therapy, much like radiation therapy, is a personal choice that at our institution, is based on a conversation between a patient and their breast surgeon or medical oncologist. It is, therefore, our typical practice to c...

This is an increasingly common scenario. The calculus has also changed from the past in that we can now offer patients with ER+ DCIS 5 fraction APBI or WBI as compared to 5 years of endocrine therapy which is far more appealing to patients and also has a very low (and different side effect) profile.

We discuss the role of endocrine therapy and outcomes with and without but similar to Dr. @Dr. First Last, we consider the independent.