Assessing the benefit of radiation therapy after breast-conserving surgery for ductal carcinoma-in-situ.
OBJECTIVE
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).


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.


CONCLUSIONS
The principal benefit associated with adding RT to BCS for DCIS seems to be its ability to reduce invasive recurrences.
Hayman
James A
JA
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI 48109-0010, USA. Hayman@umich.edu
Kabeto
Mohammed U
MU
Schipper
Matthew J
MJ
Bennett
Jonathan E
JE
Vicini
Frank A
FA
Pierce
Lori J
LJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000532:radiotherapy* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome