Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Cancer. 2012 Apr 15;118(8):2004-13. doi: 10.1002/cncr.26505. Epub 2011 Sep 27.
Radiation therapy (RT) after breast-conserving surgery (BCS) is associated with a significant reduction in ipsilateral breast tumor recurrence and breast cancer mortality rates in patients with early stage breast cancer. The authors of this report sought to determine which patients with breast cancer do not receive RT after BCS in the United States.
The Surveillance, Epidemiology, and End Results registry was used to determine the rates of RT after BCS for women with stage I through III breast cancer in the United States from 1992 through 2007. A multivariate analysis was performed to identify independent predictors of omission of RT.
In total, 294,254 patients with invasive, nonmetastatic breast cancer were identified who underwent surgery from 1992 through 2007. Most patients (57%) underwent BCS; among those, 21.1% did not receive RT after BCS. The omission of RT increased significantly from 1992 (15.5%) to 2007 (25%). The receipt of RT also decreased significantly for patients with increased cancer stage, age <55 years, high-grade tumors, large tumors, positive or untested lymph node status, African American or Hispanic race, and negative or unknown estrogen receptor status. Significant geographic variation was observed in the rates of RT after BCS.
The omission of RT after BCS was more common in recent years, especially among women who had an increased risk of breast cancer recurrence. This trend represents a serious health care concern because of the potential increased risk of local recurrence and breast cancer mortality.
保乳手术后（BCS）进行放疗（RT）与早期乳腺癌患者同侧乳房肿瘤复发率和乳腺癌死亡率的显著降低相关。本报告的作者旨在确定在美国哪些乳腺癌患者在 BCS 后未接受 RT。
使用监测、流行病学和最终结果登记处确定 1992 年至 2007 年间美国 I 期至 III 期乳腺癌女性 BCS 后接受 RT 的比率。进行多变量分析以确定 RT 遗漏的独立预测因素。
共确定了 294254 例接受手术治疗的浸润性非转移性乳腺癌患者，这些患者在 1992 年至 2007 年间接受了手术。大多数患者（57%）接受了 BCS；其中，21.1%在 BCS 后未接受 RT。从 1992 年（15.5%）到 2007 年（25%），RT 遗漏显著增加。随着癌症分期增加、年龄<55 岁、高级别肿瘤、大肿瘤、阳性或未检测的淋巴结状态、非裔美国人或西班牙裔、阴性或未知的雌激素受体状态，接受 RT 的患者数量也显著减少。在 BCS 后 RT 的比率方面观察到显著的地理差异。
近年来，BCS 后 RT 遗漏更为常见，尤其是在乳腺癌复发风险增加的女性中。这种趋势是一个严重的医疗保健问题，因为局部复发和乳腺癌死亡率的潜在风险增加。
