Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ - The LORD study

Lotte E. Elshof, Konstantinos Tryfonidis, Leen Slaets, A. Elise van Leeuwen-Stok, Victoria P. Skinner, Nicolas Dif, Ruud M. Pijnappel, Nina Bijker, Emiel J. Th. Rutgers, Jelle Wesseling*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: The current debate on overdiagnosis and overtreatment of screen-detected ductal carcinoma in situ (DCIS) urges the need for prospective studies to address this issue. A substantial number of DCIS lesions will never form a health hazard, particularly if it concerns non-to slow-growing low-grade DCIS. The LORD study aims to evaluate the safety of active surveillance in women with low-risk DCIS.

Design: This is a randomised, international multicentre, open-label, phase III non-inferiority trial, led by the Dutch Breast Cancer Research Group (BOOG 2014-04) and the European Organization for Research and Treatment of Cancer (EORTC-BCG 1401). Standard treatment will be compared to active surveillance in 1240 women aged P45 years with asymptomatic, screen-detected, pure low-grade DCIS based on vacuum-assisted biopsies of microcalcifications only. Both study arms will be monitored with annual digital mammography for a period of 10 years. The primary end-point is 10-year ipsilateral invasive breast cancer free percentage. Secondary end-points include patient reported outcomes, diagnostic biopsy rate during follow-up, ipsilateral mastectomy rate and translational research.

Feasibility: To explore interest in and feasibility of the LORD study we conducted a survey among EORTC and BOOG centres. A vast majority of EORTC and BOOG responding centres expressed interest in participation in the LORD study. The proposed study design is endorsed by nearly all centres. (C) 2015 The Authors. Published by Elsevier Ltd.

Original languageEnglish
Pages (from-to)1497-1510
Number of pages14
JournalEuropean Journal of Cancer
Volume51
Issue number12
DOIs
Publication statusPublished - Aug 2015

Keywords

  • Ductal carcinoma in situ
  • Low-grade
  • Overdiagnosis
  • Overtreatment
  • Surgery
  • Radiotherapy
  • Hormonal therapy
  • Active surveillance
  • BREAST-CONSERVING TREATMENT
  • DIFFERENT GENETIC PATHWAYS
  • SCREEN-FILM MAMMOGRAPHY
  • LOCAL RECURRENCE
  • NATURAL-HISTORY
  • ADJUVANT BREAST
  • CANCER
  • DCIS
  • RADIOTHERAPY
  • DIAGNOSIS

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