Abstract P4-11-10: Breast cancer patients' preferences for adjuvant radiotherapy post-lumpectomy: Whole breast irradiation versus partial breast irradiation-single institutional study
Authors: Szumacher EF , McGuffin M , Presutti R , Pignol IP , Harth T , Mesci A , Feldman-Stewart D , Chow E , DiProspero L , Vesprini D , Rakovitch E , Lee J , Doherty M , Soliman H , Ackerman I , Cao X , Kiss A 
Published: May 2016

Background

The standard regimen of radiotherapy following lumpectomy consists of whole breast irradiation (WBI) to the entire breast including the lumpectomy cavity and all the surrounding normal breast tissue. Recently, there has been increased interest in partial breast irradiation (PBI) as an alternative to WBI. However, the preferences of patients with early breast cancer as to what type of radiotherapy regimen post lumpectomy they would prefer and why is unclear in the literature. This study was conducted to determine whether patients with early stage breast cancer would prefer PBI or WBI and to identify important factors for patients when making their treatment decision.

Methods

Based on our previous study of early stage breast cancer patient information needs, the relevant literature and the ASTRO consensus statement guidelines, an educational tool and questionnaire were developed. New patients with early breast cancer who were referred for adjuvant radiotherapy at the large academic cancer center were invited to participate. Women &gt;40 years of age with a new histological diagnosis of ductal carcinoma in-situ or invasive breast carcinoma treated with breast conserving surgery showing clear margins for non-invasive and invasive disease and negative axillary nodes were eligible. Descriptive statistics were calculated for all variables of interest. Survey question responses were compared between those preferring WBI or PBI using chi-square analyses or Fisher's exact tests.

Results

Ninety /126 patients who were approached about this study completed the survey, 27(30%) preferred PBI and 55(62%) preferred WBI. Four patients (4%) required more information to choose between WBIvsPBI, and 3 patients (3%) had no preferences. From patients who choose WBI,32(58%)patients preferred hypofractionated RTvs 14 (25%)conventional RTregimen,Factors rated as important by patients in making their decision included convenience [PBI=18/26(69%), WBI=36/54(67%)], financial factors [PBI=14/26(53%), WBI=21/55(38%)], radiation dose to the breast [PBI=20/26(80%), WBI=46/55(83%)], invasiveness [PBI=18/26(69%), WBI=43/53(81%),, recurrence rate [PBI=26/26(100%), WBI=55/55(100%)], survival [PBI=26/26(100%),WBI=54/55(98%)], side effects PBI 21/26 (81%) WBI 47/55(85%) effectiveness [PBI=25/26(96%),WBI=54/54(100%)], standard method of treatment [PBI=16/26(61%), WBI=52/54(96%), p=0.001] and radiation dose to surrounding organs [PBI=23/26(88%), WBI=52/54(95%)].

Conclusions

Our study shows that patients with early breast cancer prefer WBI as an adjuvant treatment post lumpectomy. There is significant association between preference of treatment and importance of standard treatment. Patients preferring WBRT were more likely to consider standard treatment as more important than those preferring PBI.There was a marginally significant association between marital status and preference of radiotherapy(p=0.0773) and employment (p=0.0667).Those currently not employed were marginally more likely to prefer WBI than those currently employed. A detailed analysis of all decisional preferences between WBI and PBI will be presented at the meeting.

Citation Format: Szumacher EF, McGuffin M, Presutti R, Pignol IP, Harth T, Mesci A, Feldman-Stewart D, Chow E, DiProspero L, Vesprini D, Rakovitch E, Lee J, Doherty M, Soliman H, Ackerman I, Cao X, Kiss A. Breast cancer patients' preferences for adjuvant radiotherapy post-lumpectomy: Whole breast irradiation versus partial breast irradiation-single institutional study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-10.