Top Line: Can a 12-gene DCIS Score (DS) safely guide which patients can skip radiation after lumpectomy?
The Study: ECOG-ACRIN E4112 put the DS to the test as a decision aid in selecting adjuvant radiation. Among 339 patients with DCIS, 171 ultimately had a margin negative lumpectomy and a DS to guide adjuvant therapy. Of these, 48% had a low risk DS (<39) and 52% had an intermediate or high risk DS. Low risk patients were advised to omit adjuvant RT while those with intermediate or high risk were advised to receive RT. Impressively, 93% followed their DS-based recommendation. At 5 years, ipsilateral in-breast event (IBE) rates hovered around 1% per year in both groups (5.1% with low DS and 4.5% with high DS). These recurrence rates are markedly lower than historical data for lumpectomy alone (∼2.5% per year) and on par with outcomes after radiation in earlier trials like ECOG 5194.
TBL: In this trial, the 12-gene DS was successfully used to tailor adjuvant radiation recommendations to allow some low risk patients to omit radiation while reducing recurrence risk in higher risk patients. | Khan, JAMA Oncol 2025
The Study: ECOG-ACRIN E4112 put the DS to the test as a decision aid in selecting adjuvant radiation. Among 339 patients with DCIS, 171 ultimately had a margin negative lumpectomy and a DS to guide adjuvant therapy. Of these, 48% had a low risk DS (<39) and 52% had an intermediate or high risk DS. Low risk patients were advised to omit adjuvant RT while those with intermediate or high risk were advised to receive RT. Impressively, 93% followed their DS-based recommendation. At 5 years, ipsilateral in-breast event (IBE) rates hovered around 1% per year in both groups (5.1% with low DS and 4.5% with high DS). These recurrence rates are markedly lower than historical data for lumpectomy alone (∼2.5% per year) and on par with outcomes after radiation in earlier trials like ECOG 5194.
TBL: In this trial, the 12-gene DS was successfully used to tailor adjuvant radiation recommendations to allow some low risk patients to omit radiation while reducing recurrence risk in higher risk patients. | Khan, JAMA Oncol 2025