Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ: 20 years follow-up in the randomized SweDCIS Trial

J Clin Oncol. 2014 Nov 10;32(32):3613-8. doi: 10.1200/JCO.2014.56.2595. Epub 2014 Oct 13.


Purpose: Four randomized studies show that adjuvant radiotherapy (RT) lowers the risk of subsequent ipsilateral breast events (IBEs) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) by approximately 50% after 10 to 15 years. We present 20 years of follow-up data for the SweDCIS trial.

Patients and methods: Between 1987 and 1999 1,046 women were randomly assigned to RT or not after BCS for primary DCIS. Results up to 2005 have been published, and we now add another 7 years of follow-up. All breast cancer events and causes of death were registered.

Results: There were 129 in situ and 129 invasive IBEs. Absolute risk reduction in the RT arm was 12.0% at 20 years (95% CI, 6.5 to 17.7), with a relative risk reduction of 37.5%. Absolute reduction was 10.0% (95% CI, 6.0 to 14.0) for in situ and 2.0% (95% CI, -3.0 to 7.0) for invasive IBEs. There was a nonstatistically significantly increased number of contralateral events in the RT arm (67 v 48 events; hazard ratio, 1.38; 95% CI, 0.95 to 2.00). Breast cancer-specific death and overall survival were not influenced. Younger women experienced a relatively higher risk of invasive IBE and lower effect of RT. The hazard over time looked different for in situ and invasive IBEs.

Conclusion: Use of adjuvant RT is supported by 20-year follow-up. Modest protection against invasive recurrences and a possible increase in contralateral cancers still call for a need to find groups of patients for whom RT could be avoided or mastectomy with breast reconstruction is indicated.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / radiotherapy*
  • Breast Neoplasms / surgery*
  • Carcinoma in Situ / diagnosis
  • Carcinoma in Situ / radiotherapy*
  • Carcinoma in Situ / surgery*
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Mammography / methods
  • Mass Screening / methods
  • Mastectomy, Segmental / methods*
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Outcome Assessment, Health Care / statistics & numerical data
  • Proportional Hazards Models
  • Radiotherapy, Adjuvant
  • Sensitivity and Specificity
  • Survival Analysis
  • Sweden
  • Time Factors