Post-operative radiotherapy for ductal carcinoma in situ of the breast--a systematic review of the randomised trials

Breast. 2009 Jun;18(3):143-9. doi: 10.1016/j.breast.2009.04.003. Epub 2009 May 17.


Aim: To summarise the results of randomised trials testing the addition of radiotherapy (RT) to breast conserving surgery for ductal carcinoma in situ (DCIS); to determine whether there are subsets of women with DCIS who do not benefit from RT; and to determine what the balance may be between reduction in risk of recurrence and long-term toxicity.

Methods: We performed a systematic review to resolve these questions, using standard Cochrane methodology to identify, select and appraise relevant randomised trials.

Results: Four randomised controlled trials involving 3925 women were identified. All were high quality with minimal risk of bias. Analysis confirmed a statistically significant benefit from the addition of radiotherapy on all ipsilateral breast events (HR=0.49; 95% CI 0.41-0.58, p<0.00001). All subgroups analysed (margin status, age and grade) benefited from the addition of radiotherapy. Nine women require treatment with radiotherapy to prevent one ipsilateral breast recurrence (NNT=9). Deaths due to vascular disease, pulmonary toxicity and second cancers were low and not significantly higher for women who received radiotherapy.

Concluding statement: Radiotherapy was beneficial in all clinically relevant subgroups. Longer follow-up is required to detect any long-term toxicity from use of radiotherapy. To date, no increase in toxicity has been identified.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Breast Neoplasms / radiotherapy*
  • Breast Neoplasms / surgery
  • Carcinoma in Situ / radiotherapy*
  • Carcinoma in Situ / surgery
  • Carcinoma, Ductal, Breast / radiotherapy*
  • Carcinoma, Ductal, Breast / surgery
  • Combined Modality Therapy / methods
  • Female
  • Humans
  • Mastectomy, Segmental
  • Middle Aged
  • Odds Ratio
  • Postoperative Care / methods
  • Prognosis
  • Radiotherapy, Adjuvant / adverse effects
  • Radiotherapy, Adjuvant / methods*
  • Randomized Controlled Trials as Topic
  • Treatment Outcome
  • Women's Health