Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama.
University of Alabama at Birmingham, Birmingham, Alabama.
Breast J. 2019 Nov;25(6):1206-1213. doi: 10.1111/tbj.13444. Epub 2019 Jul 29.
American Society of Radiation Oncology Choosing Wisely campaign recommends hypofractionated radiation and against routine use of intensity-modulated radiation therapy (IMRT) in early-stage estrogen receptor-positive breast cancer. We analyzed guideline recommendation adherence and financial implications in a modern Medicare cohort of women treated across the southeastern United States.
Our study population comprised Medicare patients over 65 years of age with breast cancer diagnosis from 12 cancer centers in the Southeast United States with stage 0-II breast treated with lumpectomy from 2012 to 2015. Hypofractionation was defined as 4 or fewer weeks of radiation treatments. Factors associated with utilization of hypofractionation and IMRT were identified using Poisson regression. Median costs during radiation treatments were compared for hypofractionation and IMRT.
In older women (median age 71), 75% were treated with conventional fractionation, and 20% received IMRT. Hypofractionated women were more likely to have a positive estrogen(ER) or progestorone(PR) receptor status, lower comorbidity scores, and be treated at a high volume center (all P < 0.05). IMRT was utilized in 20% of patients and was more common in women treated with conventional fractionation (P < 0.001). Positive ER/PR status (P < 0.001) and utilization of hormonal blockade (P = 0.02) were associated with increased utilization of IMRT.
In an older cohort of patients with early-stage breast cancer, a majority were treated with conventional fractionated radiation, while approximately 20% were treated with IMRT. Both of which were associated with increased cost relative to hypofractionation.
美国放射肿瘤学会选择明智运动建议对早期雌激素受体阳性乳腺癌进行低分割放射治疗，反对常规使用调强放射治疗（IMRT）。我们分析了美国东南部一个现代医疗保险队列中妇女的指南建议遵守情况和经济影响。
我们的研究人群包括来自美国东南部 12 个癌症中心的年龄在 65 岁以上的医疗保险患者，他们患有乳腺癌，分期为 0-II 期，采用乳房切除术治疗，从 2012 年至 2015 年接受放射治疗。低分割定义为 4 周或更短的放射治疗。使用泊松回归确定与低分割和 IMRT 使用率相关的因素。比较低分割和 IMRT 放射治疗期间的中位费用。
在老年妇女（中位年龄 71 岁）中，75%接受常规分割治疗，20%接受 IMRT。低分割组妇女更有可能具有阳性雌激素（ER）或孕激素（PR）受体状态、较低的合并症评分，并在高容量中心接受治疗（均 P<0.05）。20%的患者接受了 IMRT，且在接受常规分割治疗的患者中更为常见（P<0.001）。ER/PR 阳性状态（P<0.001）和激素阻断的使用（P=0.02）与 IMRT 使用率的增加相关。
在一个早期乳腺癌老年患者队列中，大多数患者接受常规分割放射治疗，而约 20%接受 IMRT 治疗。与低分割相比，这两种治疗方法都与成本增加有关。
