Kerba M, Miao Q, Zhang-Salomons J, Mackillop W
Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
Clin Oncol (R Coll Radiol). 2007 Sep;19(7):481-9. doi: 10.1016/j.clon.2007.03.013. Epub 2007 Apr 27.
Determining the appropriate rate of radiotherapy is important for ensuring optimal radiotherapy utilisation and accessibility. A criterion-based benchmark (CBB) was developed for estimating the need for radiotherapy in incident breast cancer cases. Our primary objective was to compare an evidence-based estimate (Ebest) of need against the CBB. These estimates were then compared with radiotherapy rates in Ontario, Canada and the USA. Surgical rates were also examined.
Benchmarks were defined in Ontario as communities in proximity to cancer centres and without long waiting lists. Patient data from 1997 to 2001 were prospectively collected from radiotherapy cancer centres. Surgical data were obtained from the Canadian Institute for Health Information database. The public use file of Surveillance, Epidemiology and End Results (SEER) described treatment in the USA.
In total, 4241 cases of breast cancer were diagnosed in benchmark communities. The overall radiotherapy rate by Ebest was 64.0% (95% confidence interval: 58.1-69.8%) compared with the CBB of 60.7% (59.3-62.1%). In comparison, Ontario's overall radiotherapy rate was 55.6% (55.0-56.1%) and in SEER it was 49.3% (48.9-49.6%). Adjuvant radiotherapy rates after lumpectomy were 100% in Ebest and 83.6% (82.0-85.1%) by the CBB. The Ebest and CBB post-mastectomy rates were 21.9% (20.6-23.3%) and 34.6% (32.5-36.7%), respectively. Observed post-lumpectomy radiotherapy rates were 75.1% in Ontario and 65.3% in SEER. Post-mastectomy radiotherapy rates were 29.5% in Ontario and 17.0% in SEER.
CBB provides a reasonable estimate of the overall need for radiotherapy in breast cancer. Observed radiotherapy rates in Ontario and the USA suggest an age-related decrease in the use of radiotherapy. The benchmark estimate suggests a shortfall of adjuvant breast radiotherapy utilisation in Ontario.
确定合适的放射治疗率对于确保最佳的放射治疗利用和可及性至关重要。已制定了基于标准的基准（CBB）来估计新发乳腺癌病例的放射治疗需求。我们的主要目标是将基于证据的需求估计值（Ebest）与CBB进行比较。然后将这些估计值与加拿大安大略省和美国的放射治疗率进行比较。还对手术率进行了检查。
在安大略省，将靠近癌症中心且没有长等待名单的社区定义为基准。前瞻性地从放射治疗癌症中心收集了1997年至2001年的患者数据。手术数据来自加拿大卫生信息研究所数据库。监测、流行病学和最终结果（SEER）的公共使用文件描述了美国的治疗情况。
在基准社区共诊断出4241例乳腺癌病例。Ebest的总体放射治疗率为64.0%（95%置信区间：58.1 - 69.8%），而CBB为60.7%（59.3 - 62.1%）。相比之下，安大略省的总体放射治疗率为55.6%（55.0 - 56.1%），在SEER中为49.3%（48.9 - 49.6%）。保乳术后辅助放射治疗率在Ebest中为100%，在CBB中为83.6%（82.0 - 85.1%）。Ebest和CBB的乳房切除术后率分别为21.9%（20.6 - 23.3%）和34.6%（32.5 - 36.7%）。安大略省观察到的保乳术后放射治疗率为75.1%，在SEER中为65.3%。乳房切除术后放射治疗率在安大略省为29.5%，在SEER中为17.0%。
CBB为乳腺癌放射治疗的总体需求提供了合理估计。安大略省和美国观察到的放射治疗率表明放射治疗的使用存在与年龄相关的下降。基准估计表明安大略省辅助性乳腺癌放射治疗的利用不足。
