PRIME breast cancer trial

The Post-operative Radiotherapy In Minimum risk Elderly (PRIME) breast cancer trial

This project estimated the impact on overall resource use of post-operative radiotherapy in women with a low risk of local recurrence of disease, and the cost-effectiveness of post-operative radiotherapy. Health care resources used by each patient in the 15 months following surgery were captured. Resource consumption was first measured in terms of physical quantities and then combined with unit cost data for the participating centres. The estimated difference in health outcomes, measured in QALYs, was close to zero whilst the costs were substantially higher in the radiotherapy arm. The probability that no-radiotherapy is cost-effective relative to radiotherapy was 94%. The magnitude of any excess local recurrence in patients not receiving radiotherapy is still uncertain.

Outcome and Translation

Breast cancer in older patients is a major and rising health care burden and radiotherapy is the standard therapy. This study added to the evidence on cost-effectiveness of radiotherapy. The follow-up was relatively short and no relapse was found. A follow-up trial (PRIME II) is currently being conducted to measure relapse more robustly within a longer follow-up (5 years). The HTA report has been downloaded over 12,000 times.

HERU researchers involved in this research project: Marjon van der Pol

External Collaborators: R Prescott (University of Edinburgh); I Kunkler, M Dixon, R Lindley (Western General NHS Trust) and J Cairns (LSHTM)

Publications

Prescott, RJ., Kunkler, IH., Williams, LJ., King, CC., Jack, W., Dixon, MJ., Pol, M. van der., Goh, T., Lindley, R. and Cairns, J. (2007) 'A randomised controlled trial of postoperative radiotherapy following breast-conserving surgery in a minimum-risk older population (The PRIME trial)', Health Technology Assessment, 2007, 11(31).

Pol, M. van der. (2008) 'Cost effectiveness of post-operative radiotherapy in minimum risk elderly', HERU Briefing Paper, University of Aberdeen.

Williams, LJ., Kunkler, IH., King, CC., Jack, W. and Pol, M van der. A randomised controlled trial of post-operative radiotherapy following breast-conserving surgery in a minimum-risk population. Quality of Life at five years in the PRIME trial. Health Technology Assessment. 2011; 15(12); 1-64.

Presentations

Prescott, RJ., Kunkler, IH., Williams, LJ., King, CC., Jack, W., Dixon, MJ., Pol, van der. M., Goh, TT., Lindley, R. and Cairns, J. (2006) 'PRIME I: assessing the impact of adjuvant breast radiotherapy on quality of life in low risk older patients following breast conservation', San Antonio Breast Cancer Symposium, San Antonio, December 2006.

Prescott, RJ., Kunkler, IH., Williams, LJ., King, CC., Jack, W., Dixon, MJ., Pol, M. van der., Goh, T., Lindley, R. and Cairns, J. (2007) 'Post-operative radiotherapy (RT) in minimum-risk elderly (PRIME): assessing the impact of breast radiotherapy on quality of life in low risk older patients', 10th Nottingham International Breast Cancer Conference, Nottingham, September 2007.

Kunkler, IH., Prescott, RJ., Williams, LJ., King, CC., Jack, W., Dixon, MJ. and Pol, M. van der. (2007) 'Cosmetic effect of breast radiotherapy in older women', San Antonio Breast Cancer Symposium, San Antonio, December 2007.