Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada.
Clin Breast Cancer. 2020 Oct;20(5):e612-e617. doi: 10.1016/j.clbc.2020.03.006. Epub 2020 Mar 28.
The adoption of hypofractionated radiotherapy (HFRT) into clinical practice varies widely despite randomized trials and guidelines supporting its equivalence to conventional fractionated radiotherapy (CFRT) for certain patient populations. We assessed the use of HFRT at a single institution from 2011 to 2018, as well as time-savings calculations.
A retrospective cohort study was conducted for patients with breast cancer receiving adjuvant radiotherapy by HFRT or CFRT. Trends in HFRT use (≤ 16 fractions) were stratified according to 4 subgroups: tangential breast RT, locoregional breast RT, tangential chest wall RT, and locoregional chest wall RT. Treatment time savings were approximated using the institutional median treatment time.
A total of 5190 patients were included. HFRT use in all subgroups increased from 2011 to 2018. Tangential breast HFRT alone increased from 62.2% in 2011 to 96.9% in 2018. Locoregional breast HFRT and tangential chest wall HFRT use increased from less than 10% in 2011 to 76.2% and 76.9% in 2018. In locoregional chest wall RT, HFRT use of 44.9% was observed in 2018. Increased use of locoregional HFRT was mainly due to institutional policy changes. Time-savings calculations showed that 4002 hours of treatment or an additional 1402 HFRT courses could have been administered if all patients received HFRT.
The use of HFRT at our center increased in all patient subgroups. More evidence and guidelines for patients receiving chest wall or locoregional HFRT are required because the use of HFRT remains low in these patient cohorts.
尽管随机试验和指南支持将分割剂量放疗（HFRT）应用于某些患者人群，与常规分割放疗（CFRT）等效，但 HFRT 在临床实践中的应用仍存在很大差异。我们评估了 2011 年至 2018 年在单一机构中 HFRT 的使用情况以及节省的时间计算。
对接受 HFRT 或 CFRT 辅助放疗的乳腺癌患者进行回顾性队列研究。根据 4 个亚组（切线乳房放疗、局部区域乳房放疗、切线胸部放疗和局部区域胸部放疗），对 HFRT 使用率（≤16 个剂量）的趋势进行分层。使用机构中位数治疗时间近似估计治疗时间节省。
共纳入 5190 例患者。所有亚组的 HFRT 使用均呈上升趋势，从 2011 年的 62.2%上升至 2018 年的 96.9%。单独使用切线乳房 HFRT 从 2011 年的 62.2%上升至 2018 年的 96.9%。局部区域乳房 HFRT 和切线胸部壁 HFRT 的使用率从 2011 年的不到 10%上升至 2018 年的 76.2%和 76.9%。在局部区域胸部壁放疗中，2018 年观察到 44.9%的 HFRT 使用率。局部区域 HFRT 使用率的增加主要是由于机构政策的变化。时间节省计算表明，如果所有患者都接受 HFRT，则可以进行 4002 小时的治疗或额外进行 1402 次 HFRT 疗程。
我们中心所有患者亚组的 HFRT 使用均增加。需要更多关于接受胸部壁或局部区域 HFRT 治疗的患者的证据和指南，因为在这些患者队列中 HFRT 的使用率仍然较低。
