How does one interpret the LUMINA trial in the FLORENCE APBI ERA?

While I am encouraged by the results of the LUMINA trial with respect to identifying patients who are less likely to benefit from radiation therapy when committing to endocrine therapy, did it ask the right question? "Adjuvant breast RT is usually prescribed following BCS to reduce the risk of local recurrence (LR). However, this treatment is inconvenient, costly, and associated with acute and late toxicity." These patients are generally excellent candidates for 5 fraction partial breast radiation using the Florence IMRT regimen. The regimen is more convenient and cost effective than moderately hypofractionated whole breast radiation, and the toxicity profile is very favorable. Unlike endocrine therapy, essentially all patients who will initiate 5 fraction partial breast radiation therapy will complete the therapy. Is it time to cede T1N0 luminal A patients to endocrine therapy, or simply to shift to one modality rather than multimodal adjuvant approaches?

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Radiation Oncology · Allegheny Health Network, Pittsburgh

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This is a common scenario. My practice is to discuss this with the patient. I discuss 5 fraction PBI or 5 fraction WBI depending on the scenario, as well as endocrine therapy and the differences in toxicity profiles. Given compliance rates of 50-60% with endocrine therapy long-term, many patients pr...

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Radiation Oncology · Varian Medical Systems/Allegheny health network

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Since these patients are candidates for 5 fraction APBI and 5 fraction whole breast RT, the argument about inconvenience, cost, and significant acute/late effect becomes weaker.

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Radiation Oncology · Berks Radiation Oncology Associates

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Why is no one interested in omitting anti-estrogen therapy? Many patients stop it anyway.

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Radiation Oncology · Munson Medical Center

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I've yet to meet a patient who tolerated hormone therapy better than 5 Fx APBI or 5 Fx whole breast XRT and didn't exclaim that fact very clearly at follow up appointments; yet there is a push to exclude XRT in lower risk early stage patients. We're all preaching to the choir here...

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Radiation Oncology · Kaiser Permanente Washington

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For those of you using the Florence regimen, are you restricting this to patients with a 5 mm or greater surgical margin as required on the trial?

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