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

Are there specific patient populations in which you may feel comfortable with a patient selecting only one adjuvant therapy approach (tamoxifen vs RT)? How do you help inform such a selection in patients who may be hesitant to receive both modalities? For additional reading, see JCO OGR 11/2021 by @Dr. First Last and @Dr. First Last reviewing landscape of adjuvant treatment after lumpectomy for DCIS, and companion study with longterm outcomes from RTOG 9804 (@Dr. First Last et al).

3 Answers

Mednet Member

Radiation Oncology · Memorial Sloan Kettering Cancer Center

Answered on

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...

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Mednet Member

Radiation Oncology · Dana-Farber Cancer Institute

Answered on

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 contro...

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Mednet MemberInvited Expert

Radiation Oncology · Allegheny Health Network, Pittsburgh

Answered on

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....

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