Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA.
Department of Surgical Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
Breast Cancer Res Treat. 2017 Oct;165(3):669-676. doi: 10.1007/s10549-017-4354-x. Epub 2017 Jun 23.
To evaluate the practice patterns for the use of regional nodal irradiation (RNI) in treatment of elderly women with low volume node-positive breast cancer in the setting of breast conservation surgery (BCS).
Women aged 70-89 diagnosed with unilateral, pathologic T1-2N1M0 breast cancer from 2004 to 2013, who underwent BCS and received radiotherapy were identified from the National Cancer Database. In 2011, two major trials were presented that helped define indications for RNI. Patients were dichotomized into "early", i.e. diagnosed up to 2010, and "late" cohorts. Patient and treatment characteristics were compared between the cohorts and logistic regression used to determine independent factors associated with the receipt of RNI.
7228 women met inclusion criteria; 4330 (59.9%) in early and 2898 (40.1%) in late cohorts. Utilization of RNI increased from 33.9% in early to 42.5% in late cohorts (P ≤ 0.001) and was independent of a general increase in RNI utilization. RNI in the early and late cohorts was not different between the study population and younger women (P > 0.05). RNI utilization increased in both cohorts with increasing number of positive lymph nodes. In the early cohort, RNI was also associated with higher grade, white race and lower income. In the late cohort, RNI increased with the presence of multiple, predefined risk factors.
There was an increase in utilization of RNI for elderly patients from 2004 to 2013. In more recent years, the primary factors associated with receipt of RNI were tumor related with declining importance of demographic factors.
评估在保乳手术（BCS）背景下，对低容量淋巴结阳性乳腺癌老年女性使用区域淋巴结照射（RNI）的实践模式。
从国家癌症数据库中确定了 2004 年至 2013 年间诊断为单侧、病理 T1-2N1M0 乳腺癌、年龄在 70-89 岁的女性，她们接受了 BCS 并接受了放射治疗。2011 年，两项主要试验提出了有助于确定 RNI 适应证的方法。患者分为“早期”，即 2010 年前诊断的患者，和“晚期”患者。对两组患者的特征进行比较，并采用逻辑回归分析确定与接受 RNI 相关的独立因素。
7228 名女性符合纳入标准；早期队列 4330 名（59.9%），晚期队列 2898 名（40.1%）。RNI 的使用率从早期的 33.9%上升到晚期的 42.5%（P≤0.001），且与 RNI 使用率的普遍增加无关。在研究人群中，早期和晚期队列的 RNI 与年轻女性之间没有差异（P>0.05）。在两个队列中，随着阳性淋巴结数量的增加，RNI 的使用也随之增加。在早期队列中，RNI 还与更高的分级、白人种族和较低的收入相关。在晚期队列中，RNI 随多个预先定义的危险因素的存在而增加。
2004 年至 2013 年，老年患者接受 RNI 的使用率增加。在最近几年，与接受 RNI 相关的主要因素与肿瘤有关，而人口统计学因素的重要性降低。
