The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
J Clin Oncol. 2011 Jan 10;29(2):157-65. doi: 10.1200/JCO.2009.27.0942. Epub 2010 Dec 6.
Brachytherapy is a method for delivering partial-breast irradiation after breast-conserving surgery (BCS). It is currently used in the community setting, although its efficacy has yet to be validated in prospective comparative trials. Frequency and factors influencing use have not been previously identified.
In a nationwide database of 6,882 Medicare beneficiaries (age ≥ 65 years) with private supplemental insurance (MarketScan Medicare Supplemental), claims codes identified patients treated with brachytherapy versus external-beam radiation after BCS for incident breast cancer (diagnosed from 2001 to 2006). Logistic regression modeled predictors of brachytherapy use.
Frequency of brachytherapy use as an alternative to external-beam radiation after BCS increased over time (< 1% in 2001, 2% in 2002, 3% in 2003, 5% in 2004, 8% in 2005, 10% in 2006; P < .001). Increased use correlated temporally with US Food and Drug Administration approval and Medicare reimbursement of brachytherapy technology. Brachytherapy use was more likely in women with lymph node-negative disease (odds ratio [OR], 2.19; 95% CI, 1.17 to 4.11) or axillary surgery (OR, 1.74; 95% CI, 1.23 to 2.44). Brachytherapy use was also more likely in women with non-health maintenance organization insurance (OR, 1.81; 95% CI, 1.24 to 2.64) and in areas with higher median income (OR, 1.58; 95% CI, 1.05 to 2.38), lower density of radiation oncologists (OR, 1.78; 95% CI, 1.11 to 2.86), or higher density of surgeons (OR, 1.57; 95% CI, 1.07 to 2.31).
Despite ongoing questions regarding efficacy, breast brachytherapy was rapidly incorporated into the care of older, insured patients. In our era of frequently emerging novel technologies yet growing demands to optimize costs and outcomes, results provide insight into how clinical, policy, and socioeconomic factors influence new technology diffusion into conventional care.
近距离放射疗法是一种在保乳手术后（BCS）进行部分乳房照射的方法。尽管其在前瞻性对照试验中的疗效尚未得到验证，但目前已在社区环境中使用。其使用频率和影响因素以前尚未确定。
在一项全国性的医疗保险受益人群数据库（6882 名年龄≥65 岁，有私人补充保险的 Medicare 受益人群（市场扫描 Medicare 补充）中，索赔代码识别出了在 BCS 后接受保乳手术后接受近距离放射治疗和外部束放疗的患者，以治疗原发性乳腺癌（2001 年至 2006 年确诊）。逻辑回归模型预测了近距离放射治疗使用的预测因素。
在 BCS 后，作为外部束放疗替代方法的近距离放射治疗的使用率随着时间的推移而增加（2001 年<1%，2002 年 2%，2003 年 3%，2004 年 5%，2005 年 8%，2006 年 10%；P<0.001）。使用率的增加与美国食品和药物管理局（FDA）的批准以及医疗保险对近距离放射治疗技术的报销有关。淋巴结阴性疾病（比值比[OR]，2.19；95%置信区间[CI]，1.17 至 4.11）或腋窝手术（OR，1.74；95%CI，1.23 至 2.44）的女性更有可能接受近距离放射治疗。非健康维护组织保险（OR，1.81；95%CI，1.24 至 2.64）和中位收入较高地区（OR，1.58；95%CI，1.05 至 2.38）、辐射肿瘤学家密度较低（OR，1.78；95%CI，1.11 至 2.86）或外科医生密度较高（OR，1.57；95%CI，1.07 至 2.31）的女性也更有可能接受近距离放射治疗。
尽管近距离放射治疗的疗效仍存在争议，但它已迅速纳入了对老年、有保险的患者的护理。在我们这个经常出现新的技术但又要求不断优化成本和结果的时代，研究结果提供了一些见解，了解了临床、政策和社会经济因素如何影响新技术向常规护理的扩散。
