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.
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...
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....