Gfunk6

And to think . . . I hesitated
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http://www.nytimes.com/2015/08/21/health/breast-cancer-ductal-carcinoma-in-situ-study.html?emc=edit_au_20150820&nl=afternoonupdate&nlid=58246418&_r=0

The Cochrane meta-analysis showed no OS benefit after breast radiotherapy in DCIS. This fact has also been shown by multiple, phase III randomized trials of DCIS +/- XRT.

However, a SEER study suddenly reveals this fact AGAIN and makes a big splash.

The only way to combat this misinformation is to run a trial of post-lumpectomy DCIS patients with an observation (no XRT arm).
 

napoleondynamite

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OS has never been the reason to undergo post-lumpectomy XRT for DCIS. You are right, old news.

The discussion I always have with my patients is about recurrence and that 1/2 of recurrences are invasive. Also about cosmesis, that they opted for a lumpectomy to avoid mastectomy and with a 30% chance of recurrence, XRT is the best insurance policy against a future mastectomy.

Is anyone else seeing the horrifying trend of using OncoDx to risk-stratify DCIS patients away from XRT without ever even seeing a radonc in consult? I'm not impressed that the data behind that is primetime, and yet, it's becoming standard practice in my neck of the woods among certain surgeons.
 

medgator

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OS has never been the reason to undergo post-lumpectomy XRT for DCIS. You are right, old news.

The discussion I always have with my patients is about recurrence and that 1/2 of recurrences are invasive. Also about cosmesis, that they opted for a lumpectomy to avoid mastectomy and with a 30% chance of recurrence, XRT is the best insurance policy against a future mastectomy.

Is anyone else seeing the horrifying trend of using OncoDx to risk-stratify DCIS patients away from XRT without ever even seeing a radonc in consult? I'm not impressed that the data behind that is primetime, and yet, it's becoming standard practice in my neck of the woods among certain surgeons.
A med onc in my community tried to use that on a 68 yo F with grade 3 disease. Luckily I laid the smack down as many of the surgeons I work with do dual med onc/rad onc referrals.

The oncotype DCIS assay is not explicitly endorsed anywhere in the nccn guidelines, a fact I mentioned in my consult note
 

thecarbonionangle

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the top comments in the article under the "reader's recommendations" are interesting....some real bad cringe worthy ones. Everyone get ready for the armchair oncologists who come out of the woodwork online to warn everyone about the specter of money hungry doctors who our out to take your money and deceive you. The NYT has had some real questionable reporting about some recent top stories.
 
OP
Gfunk6

Gfunk6

And to think . . . I hesitated
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What would this trial show that the SEER study, meta-analysis, and multiple phase III trials haven't already shown (no OS benefit, no DSS benefit, slight LC benefit)?
We need a trial of low risk DCIS patients defined by path factors or Oncotype randomized to surgery plus XRT vs surgery plus observation. Both arms would get AI.