Department of Radiation Oncology, Vancouver Centre, BC Cancer Agency, Vancouver, British Columbia, Canada; Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, BC Cancer Agency, Vancouver, British Columbia, Canada.
Department of Radiation Oncology, Vancouver Centre, BC Cancer Agency, Vancouver, British Columbia, Canada.
Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):829-839. doi: 10.1016/j.ijrobp.2017.02.094. Epub 2017 Mar 1.
PURPOSE: The Cancer and Leukemia Group B (CALGB) 9343 trial randomized elderly women with estrogen receptor-positive, stage 1 breast cancer to receive either hormone therapy (HT) or HT and radiation therapy (HT-RT) after lumpectomy and showed no difference in survival. After this publication, a practice guideline made HT alone a standard treatment option in British Columbia. The subsequent population-based pattern of practice was studied. METHODS AND MATERIALS: All women aged 70 to 79 years, referred after lumpectomy from 1999 to 2009, with stage 1, estrogen receptor-positive breast cancer were identified. The use of adjuvant HT or HT-RT was evaluated in 2 eras: before (1999-2003) and after (2005-2009) the CALGB publication. The proportion receiving each treatment in these eras was determined. Kaplan-Meier analyses with Cox regression were used for survival endpoints. The Fine and Gray method was used with non-breast cancer death as a competing risk for event-free survival. The Charlson score was used to quantify comorbidity. Adherence was defined as dispensation of 80% of prescribed HT. RESULTS: HT-RT was used in 91% of patients before (n=319) and 89% of patients after (n=403) the CALGB publication (P=.4). In the HT-alone group, the rate of HT adherence was 75% at 1 year and 55% at 4 years. The 10-year locoregional recurrence-free survival rate was 98% with HT-RT and 90% with HT alone (P=.01), whereas the 10-year breast cancer-specific survival rate was 96% with HT-RT and 95% with HT alone (P=.2). Patients with grade 3 histology or lymphovascular invasion were more likely to have low event-free survival. On multivariate analysis, treatment type did not predict overall survival (P=.3). CONCLUSIONS: Our patient outcomes closely matched those of the CALGB trial, suggesting that its results are generalizable to a population of elderly breast cancer patients with typical HT adherence. The CALGB trial results, as well as the resulting practice guideline, did not change the use of adjuvant HT-RT in our population-based cancer program.
目的：癌症和白血病组 B（CALGB）9343 试验将雌激素受体阳性、I 期乳腺癌的老年女性随机分为接受激素治疗（HT）或 HT 加放射治疗（HT-RT）组，在接受乳房肿瘤切除术治疗后，两组的生存情况无差异。在这项研究发表后，不列颠哥伦比亚省的一项实践指南将 HT 作为一种标准治疗选择。随后对基于人群的实践模式进行了研究。
方法和材料：所有年龄在 70 至 79 岁、接受乳房肿瘤切除术治疗后于 1999 年至 2009 年转诊、I 期、雌激素受体阳性乳腺癌的女性都被纳入研究。在两个时期评估了辅助 HT 或 HT-RT 的应用：CALGB 发表前（1999-2003 年）和发表后（2005-2009 年）。确定了这两个时期接受每种治疗的比例。采用 Kaplan-Meier 分析和 Cox 回归分析生存终点。使用 Fine 和 Gray 方法，非乳腺癌死亡作为无事件生存的竞争风险。Charlson 评分用于量化合并症。药物依从性定义为规定 HT 处方的 80%。
结果：CALGB 发表前（n=319）和发表后（n=403），HT-RT 的使用率分别为 91%和 89%（P=.4）。在单独使用 HT 的组中，1 年时 HT 使用率为 75%，4 年时为 55%。HT-RT 组和 HT 组的 10 年局部区域无复发生存率分别为 98%和 90%（P=.01），10 年乳腺癌特异性生存率分别为 96%和 95%（P=.2）。组织学分级 3 级或有淋巴血管侵犯的患者无事件生存率较低。多变量分析显示，治疗类型与总生存无相关性（P=.3）。
结论：我们的患者结局与 CALGB 试验结果非常吻合，这表明其结果可推广至具有典型 HT 依从性的老年乳腺癌患者人群。CALGB 试验结果及其导致的实践指南并未改变我们人群为基础的癌症项目中辅助 HT-RT 的应用。
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