Patient preferences regarding intraoperative versus external beam radiotherapy following breast-conserving surgery
The TARGIT-A Trial is an international randomized, prospective trial comparing intraoperative radiotherapy (IORT) for equivalence to external beam radiotherapy (EBRT) following lumpectomy for invasive breast cancer in selected low-risk patients; early results suggest that outcomes are similar. In addition to effectiveness data and cost considerations, the preferences of patients should help inform practice. This study was undertaken to explore and quantify preference in choosing between IORT and the current standard, EBRT. Eligible subjects were current or past candidates for breast-conserving surgery and radiation being seen at the University of California, San Francisco Breast Care Center. A trade-off technique varying the risk of local recurrence for IORT was used to quantify any additional accepted risk that these patients would accept to receive either treatment. Patients were first presented with a slideshow comparing EBRT with the experimental IORT option before being asked their preferences given hypothetical 10-year local recurrence risks. Patients were then given a questionnaire on demographic, social and clinical factors. Data from 81 patients were analyzed. The median additional accepted risk to have IORT was 2.3 % (−9 to 39 %), mean 3.2 %. Only 7 patients chose to accept additional risk for EBRT; 22 accepted IORT at no additional risk; and the remaining 52 chose IORT with some additional risk. Patients weigh trade-offs of risks and benefits when presented with medical treatment choices. Our results show that the majority of breast cancer patients will accept a small increment of local risk for a simpler delivery of radiation. Further studies that incorporate outcome and side effect data from the TARGIT-A trial clarify the expected consequences of a local recurrence, and include an expanded range of radiation options that could help guide clinical decision making in this area.
KeywordsBreast-conserving surgery Radiation Adjuvant radiation Intraoperative radiation IORT Patient preference
Conflict of interest
The authors declare that they have no conflict of interest.
- 5.Herzlinger R (2007) A bold new consumer-driven health care system. The laws and their legislators. Manag care 16:34–6, 39–40Google Scholar
- 7.Vaidya JS, Joseph DJ, Tobias JS et al (2010) Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 376:91–102. doi: 10.1016/S0140-6736(10)60837-9 PubMedCrossRefGoogle Scholar
- 9.Leonardi MC, Maisonneuve P, Mastropasqua MG et al (2013) Accelerated partial breast irradiation with intraoperative electrons: using GEC-ESTRO recommendations as guidance for patient selection. Radiother Oncol J Eur Soc Ther Radiol Oncol 106:21–27. doi: 10.1016/j.radonc.2012.10.018 CrossRefGoogle Scholar
- 11.Palda VA, Llewellyn-Thomas HA, Mackenzie RG et al (1997) Breast cancer patients’ attitudes about rationing postlumpectomy radiation therapy: applicability of trade-off methods to policy-making. J Clin Oncol Off J Am Soc Clin Oncol 15:3192–3200Google Scholar
- 14.Llewellyn-Thomas HA (1997) Investigating patients’ preferences for different treatment options. Can J Nurs Res = Revue canadienne de recherche en sciences infirmières 29:45–64Google Scholar
- 16.Brownlee S (2007) Overtreated: why too much medicine is making us sicker and poorer. Bloomsbury, New YorkGoogle Scholar
- 20.Vaidya JS, Tobias JS, Baum M et al (2004) Intraoperative radiotherapy for breast cancer. Lancet 44:67–73Google Scholar
- 21.Mohammed R. S. Keshtgar, Norman R. Williams, Max Bulsara et al (2013) Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomized controlled trial. Breast Cancer Res Treat 140:519–525Google Scholar