DCISionRT, anyone using it?

[Mandelin Rain]

Hate the name BTW.

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[thecarbonionangle]

This ain’t it chief

 

[Mandelin Rain]

Breast surgeon pushing hard on this registry trial. Looked up the "data" listed on their site, and it's like a few abstracts about validating it using the SwedeDCIS trial. Nothing else. My patient population doesn't look very Swedish, though.

 

[medgator]

As often as I use OncotypeDX for DCIS?

 

[scarbrtj]

No I use the Van Nuys Prognostic Index (heh). Silverstein, the VNPI guy, also this guy associated with this thing.

 

[Mandelin Rain]

As often as I use OncotypeDX for DCIS?

This is my take on it too. I'm uncertain what industry shill got in the surgeon's ear, but you can be sure something happened there. I'm not sure I feel great about making recommendations based solely on a so-called "retrospective prospective" molecular fishing experiment from a largely homogenous, yet foreign population that has yet to be "prospectively prospectively" validated in any other setting.

Also, the test probably costs twice as much as a 3 week course of XRT.

 

[Mandelin Rain]

So I did a bit of a deep dive on this retrospective-prospective model. It's amazing to me how widely adopted and used OnctotypeDX was before the published results of TAILORx were available. It's one of the most important decision points in a person's life and you're basing a it on a retrospective analysis of the tissue bank of a super old clinical trial, using a different cut off point (more favorable) to define low-risk? It's not like the harm of undertreating was local recurrence of DCIS, it was the potential development of metastatic breast cancer. Granted, there were also more severe risks to overtreatment than with radiation as well. Obviously, everything worked out fine for OncotypeDX, but it was seemingly ubiquitous before the prospective validation trial hit the NEJM in 2015.

 

[evilbooyaa]

Never heard of it. I thought Oncotype DCIS was a thing (which I haven't seen routinely used either, but would at least consider if requested).

 

[medgator]

Never heard of it. I thought Oncotype DCIS was a thing (which I haven't seen routinely used either, but would at least consider if requested).

The funny thing is that the DCIS Oncotype still hasn't made into the nccn... At least last I checked

 

[BobbyHeenan]

There was a good review of the the data on the ACR Journal Advisor not long ago. There is better strength of data for DCISionRT (external validation) than that of Oncotype DCIS in my opinion.

I use it very rarely though as another decision tool, especially in low risk patients I'm thinking of observing anyway.

The marketers/reps really push this on the breast radiologists/breast centers and surgeons more so than rad onc. They are ordering it, and even ordering it pre-op even though they need to know post op size to get an accurate score. It's craziness but happening.

As I recall nothing about it much on NCCN.