Increase in Hypofractionated Radiation Therapy Among Patients with Invasive Breast Cancer or Ductal Carcinoma In Situ: Who is Left Behind?

IF 3.4 3区医学 Q2 ONCOLOGY Practical Radiation Oncology Pub Date : 2024-09-01 DOI:10.1016/j.prro.2024.04.010

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Abstract

Purpose

We aimed to update the trend of hypofractionated whole-breast irradiation (HF-WBI) use over time in the US and examine factors associated with lack of HF-WBI adoption for patients with early-stage invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) undergoing a lumpectomy.

Methods and Materials

Among patients who underwent a lumpectomy, we identified 928,034 patients with early-stage IBC and 330,964 patients with DCIS in the 2004 to 2020 National Cancer Database. We defined HF-WBI as 2.5-3.33 Gy/fraction to the breast and conventionally fractionated WBI as 1.8-2.0 Gy/fraction. We evaluated the trend of HF-WBI utilization using a generalized linear model with the log link and binomial distribution. Factors associated with HF-WBI utilization were assessed using multivariable logistic regression in patients diagnosed between 2018 and 2020.

Results

Among patients with IBC, HF-WBI use has significantly increased from 0.7% in 2004 to 63.9% in 2020. Similarly, HF-WBI usage among patients with DCIS has also increased significantly from 0.4% in 2004 to 56.6% in 2020. Black patients with IBC were less likely than White patients to receive HF-WBI (adjusted odds ratio [AOR] 0.81; 95% CI, 0.77-0.85). Community cancer programs were less likely to administer HF-WBI to patients with IBC (AOR, 0.80; 95% CI, 0.77-0.84) and to those with DCIS (AOR, 0.87; 95% CI, 0.79-0.96) than academic/research programs. Younger age, positive nodes, larger tumor size, low volume programs, and facility location were also associated with lack of HF-WBI adoption in both patient cohorts.

Conclusions

HF-WBI utilization among postlumpectomy patients has significantly increased from 2004 to 2020 and can finally be considered standard of care in the US. We found substantial disparities in adoption within patient and facility subgroups. Reducing disparities in HF-WBI adoption has the potential to further alleviate health care costs while improving patients’ quality of life.

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浸润性乳腺癌或原位导管癌患者接受低分次放疗的人数增加：谁被落下了？

目的：我们旨在更新美国随着时间推移使用低分次全乳照射（HF-WBI）的趋势，并研究接受肿块切除术的早期浸润性乳腺癌（IBC）或导管原位癌（DCIS）患者未采用HF-WBI的相关因素：在接受肿块切除术的患者中，我们在 2004-2020 年全国癌症数据库中识别出 928,034 名早期 IBC 患者和 330,964 名 DCIS 患者。我们将乳腺高频-全乳腺照射定义为 2.5-3.33 Gy/分次，将传统的全乳腺分次照射定义为 1.8-2.0 Gy/分次。我们使用对数链接和二项分布的广义线性模型评估了高频-全乳腺放射治疗的使用趋势。在2018年至2020年期间确诊的患者中，我们使用多变量逻辑回归评估了与高频-WBI使用相关的因素：在IBC患者中，高频-WBI的使用率从2004年的0.7%大幅增至2020年的63.9%。同样，DCIS 患者中高频-WBI 的使用率也从 2004 年的 0.4% 显著增至 2020 年的 56.6%。与白人患者相比，黑人 IBC 患者接受高频-WBI 的可能性较低（调整后的几率比 [AOR] 0.81，95% CI：0.77-0.85）。与学术/研究项目相比，社区癌症项目不太可能对 IBC 患者（AOR 0.80，95% CI：0.77-0.84）和 DCIS 患者（AOR 0.87，95% CI：0.79-0.96）实施 HF-WBI。年龄较小、结节阳性、肿瘤较大、手术量较少以及医疗机构所在地也与两组患者均未采用高频-WBI有关：结论：从2004年到2020年，乳房切除术后患者对高频-WBI的使用率显著增加，在美国最终可被视为标准护理。我们发现，在患者和医疗机构亚群中，采用率存在很大差异。缩小高频生物输导技术的使用差距有可能进一步降低医疗成本，同时提高患者的生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Practical Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.20

自引率

6.10%

发文量

177

审稿时长

34 days

期刊介绍： The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes: Original articles focusing on patient safety, quality measurement, or quality improvement initiatives Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues ASTRO guidelines, position papers, and consensus statements Essays that highlight enriching personal experiences in caring for cancer patients and their families.