Abstract
Background
Broad patterns of use of the gene signature panel Oncotype DX DCIS and its large-scale
impact on postoperative administration of radiation therapy in women with ductal carcinoma
in situ of the breast remain unclear. This study sought to evaluate the patterns of
use of this gene signature panel in women with ductal carcinoma in situ and the impact
of these tools on postoperative radiation therapy administration.
Methods
The National Cancer Database was queried for women with ductal carcinoma in situ treated
with breast-conserving therapy who had information regarding whether a gene signature
panel was performed between 2010 and 2015. Demographic characteristics, the characteristics
of their ductal carcinoma in situ, and whether they received postoperative radiation
therapy were compared among patients who did have a gene signature panel performed
and those who did not. Patterns of radiation therapy administration were also evaluated
based on the recurrence risk score by the gene signature panel.
Results
Gene signature panel use increased over time, with a sharp increase in utilization
occurring in 2015 (8.0% in 2015 vs 4.4% in 2014, P < .001). Patients with estrogen receptor–positive ductal carcinoma in situ were somewhat
more likely to have a gene signature panel ordered (3.9% estrogen receptor positive
vs 1.7% estrogen receptor negative, P < .001), as were patients with lower-grade ductal carcinoma in situ (4.5% grade I/II
vs 3.1% grade III, P < .001). Gene signature panel utilization was associated with a decrease in the administration
of postoperative radiation therapy (48.6% gene signature panel vs 83.4% no gene signature
panel, P < .001). Among patients in whom a gene signature panel was performed, postoperative
radiation therapy was administered in 81.9%, 72.0%, and 35.9% of patients with high-,
intermediate-, and low-recurrence scores, respectively.
Conclusion
Gene signature panel use in patients with ductal carcinoma in situ has increased over
time and is more commonly used in women with lower-risk, clinicopathologic features
to determine the magnitude of benefit afforded by radiation therapy. Gene signature
panel use is associated with decreased rates of postoperative radiation therapy administration,
particularly among patients with scores suggesting a low rate of recurrence.
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Article info
Publication history
Published online: July 20, 2019
Accepted:
April 16,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
