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Assessing the Benefit of Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma-In-Situ

From the Departments of Radiation Oncology and Internal Medicine, and Division of General Medicine and Biostatistics, University of Michigan Health System, Ann Arbor; Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI; and Division of Emergency Medicine, A.I. duPont Hospital for Children, Wilmington, DE

Address reprint requests to James A. Hayman, MD, Department of Radiation Oncology, University of Michigan Medical Center, UH B2C490, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0010; e-mail: Hayman{at}umich.edu

PURPOSE: To assess women's preferences regarding the trade-off between the risks and benefits of treatment with radiation therapy (RT) after breast-conserving surgery (BCS) for ductal carcinoma-in-situ (DCIS).

PATIENTS AND METHODS: Utilities were obtained from 120 patients and 210 nonpatients for eight relevant health states using standard gambles.

RESULTS: Differences in utilities obtained from patient and nonpatient participants between health states were relatively similar. Reduction in the likelihood of local recurrence associated with RT did not result in higher utilities. Utilities for noninvasive recurrence were only lower after initial treatment with RT. Patient and nonpatient participants had the lowest utilities for invasive local recurrence, regardless of initial treatment or manner of salvage therapy. When comparing patient and nonpatient utilities directly, patients had higher utility for being without recurrence after initial RT and lower utility for invasive recurrence salvaged by mastectomy after initial BCS alone. None of the clinical or sociodemographic factors examined explained more than 5% of the variability in the patients' or nonpatients' utilities or their differences.

CONCLUSION: The principal benefit associated with adding RT to BCS for DCIS seems to be its ability to reduce invasive recurrences.

Supported by Clinical Research Training Grant for Junior Faculty No. CRTG-99-248-01-CCE from the American Cancer Society.

Presented in part at the 37th Annual Meeting of the American Society of Clinical Oncology, San Francisco, CA, May 12-15, 2001.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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