Ninety Days of Preoperative Endocrine Therapy Informs Patient and Physician Preference for Radiation Therapy: Primary Results from the Preoperative Window of Endocrine Therapy to Inform Radiation Therapy Decisions (POWER) Trial
Abstract
Background: Clinical trial data support the omission of radiation therapy (RT) in older women with early-stage breast cancer. The majority of older women still receive RT largely due to a lack of insight regarding endocrine therapy (ET) tolerance. The POWER trial is a phase II trial designed to determine whether 90 days of preoperative ET (pre-ET) changes patient or surgeon preferences for RT.
Methods: Between 2020 and 2024, two centers enrolled women aged 65 years or older with invasive carcinoma measuring ≤2 cm, N0, and ER+/PR±/HER2-. All participants were recommended for 90 days of pre-ET. Patient and surgeon preferences for RT were evaluated before and after pre-ET. A change in preference was tested from an assumed low change rate of 5% to a rate of ≥15%, with a one-sided 5% level binomial test.
Results: Seventy-five women enrolled. Adverse events attributed to pre-ET occurred in 35 participants (47%). After pre-ET, 21 (28.0%) patients changed RT preference and surgeons changed RT recommendation for 18 (24.0%) patients (p < 0.001 and p = 0.015, respectively). General agreement between patient and surgeon preferences before pre-ET was 53% (Kappa = -0.04) and increased to 81% (Kappa = 0.59) after pre-ET.
Conclusion: Pre-ET significantly changed patient and surgeon preferences for RT and increased patient and surgeon agreement. The intentional resequencing of treatments enables patients to assess tolerance to ET before deciding whether to omit RT. This study validates…
How strong is the evidence?
Evidence Hub reads this as a clinical trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 35 participants or records.
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