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

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...

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.

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

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...

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?