Harvard Radiation Oncology Program, Boston, MA, USA.
J Natl Cancer Inst. 2012 Jan 4;104(1):29-41. doi: 10.1093/jnci/djr495. Epub 2011 Dec 16.
Accelerated partial breast irradiation using brachytherapy (APBIb) is an alternative to whole-breast irradiation (WBI) after breast-conserving surgery. We evaluated patterns of APBIb use with respect to 2009 American Society for Radiation Oncology consensus guidelines (ASTRO-G) in a population-based cohort.
From Surveillance, Epidemiology, and End Results data, we identified 138 815 American women with breast cancer diagnosed between January 1, 2000, and December 31, 2007, who underwent WBI or APBIb after breast-conserving surgery and classified them as suitable, cautionary, or unsuitable for APBIb according to ASTRO-G criteria. Logistic regression was applied to study APBIb use overall and within each guideline category. All P values are from two-sided tests.
Overall, 2.6% of patients received APBIb, and 65.8% of them were classified as cautionary or unsuitable. APBIb was used by 5% of suitable, 3.4% of cautionary, and 1.6% of unsuitable patients by ASTRO-G criteria (P < .001). APBIb use increased from 0.4% in 2000 to 6.6% in 2007 and varied widely (0%-7%) between localities. Variables associated with APBIb use among suitable patients included other vs white race (odds ratio [OR] = 0.51, P < .001), region (OR = 2.60-8.62, P < .001), and more recent year (OR = 20.3, P < .001). Among cautionary patients, variables associated with APBIb use included black vs white race (OR = 0.76, P = .027), other vs white race (OR = 0.57, P < .001), Hispanic ethnicity (OR = 0.75, P = .036), region (OR = 3.10-10.2, P < .001), nonmetropolitan or rural location (OR = 0.53, P = .012), and more recent year (OR = 17.6, P < .001). Among unsuitable patients, black vs white race (OR = 0.77, P = .008), other vs white race (OR = 0.46, P < .001), region (OR = 3.33-21.6, P < .001), and more recent year (OR = 12.7, P < .001) were associated with APBIb use.
APBIb after breast-conserving surgery has been rapidly adopted in the United States. Use varied by race, ethnicity, and widely by region, especially among patients who may not be suitable for this radiation technique.
在保乳手术后，采用近距离放射治疗（APBIb）是全乳放射治疗（WBI）的替代方法。我们在基于人群的队列中，根据 2009 年美国放射肿瘤学会共识指南（ASTRO-G）评估了 APBIb 的使用情况。
从监测、流行病学和最终结果数据中，我们确定了 138815 名美国女性，她们在 2000 年 1 月 1 日至 2007 年 12 月 31 日期间被诊断患有乳腺癌，并在保乳手术后接受了 WBI 或 APBIb，并根据 ASTRO-G 标准将她们分类为适合、谨慎或不适合 APBIb。应用逻辑回归研究了总体上和每个指南类别中的 APBIb 使用情况。所有 P 值均来自双侧检验。
总体而言，有 2.6%的患者接受了 APBIb，其中 65.8%的患者被归类为谨慎或不适合。根据 ASTRO-G 标准，5%的适合患者、3.4%的谨慎患者和 1.6%的不适合患者接受了 APBIb（P<0.001）。APBIb 的使用从 2000 年的 0.4%增加到 2007 年的 6.6%，且在不同地区差异很大（0%-7%）。适合患者接受 APBIb 的相关因素包括其他种族与白种人（比值比[OR] = 0.51，P<0.001）、地区（OR = 2.60-8.62，P<0.001）和较晚的年份（OR = 20.3，P<0.001）。对于谨慎患者，与接受 APBIb 相关的因素包括黑人与白种人（OR = 0.76，P=0.027）、其他种族与白种人（OR = 0.57，P<0.001）、西班牙裔（OR = 0.75，P=0.036）、地区（OR = 3.10-10.2，P<0.001）、非城市或农村地区（OR = 0.53，P=0.012）和较晚的年份（OR = 17.6，P<0.001）。对于不适合患者，黑人与白种人（OR = 0.77，P=0.008）、其他种族与白种人（OR = 0.46，P<0.001）、地区（OR = 3.33-21.6，P<0.001）和较晚的年份（OR = 12.7，P<0.001）与接受 APBIb 相关。
保乳手术后的 APBIb 在美国已迅速被采用。使用情况因种族、族裔而异，且因地区而异，尤其是在可能不适合这种放射技术的患者中差异更大。
