Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
University of Virginia School of Nursing, Charlottesville, Virginia.
J Surg Res. 2020 Dec;256:577-583. doi: 10.1016/j.jss.2020.07.023. Epub 2020 Aug 14.
The results of the Cancer and Leukemia Group B (CALGB) 9343 trial showed that radiation therapy (RT) did not improve survival for women older than 70 y with early-stage estrogen receptor + breast cancer treated with breast conserving surgery and adjuvant endocrine therapy. In 2005, guidelines were modified to allow for RT omission; however, minimal change in clinical practice has occurred. The aim of this study was to determine if CALGB long-term follow-up data have affected RT utilization, and to characterize the population still receiving RT after breast conserving surgery.
The Surveillance, Epidemiology, and End Results-Medicare database was used to identify women diagnosed with early-stage breast cancer from 2004 to 2015 who matched the CALGB 9343 inclusion criteria. Multivariate logistic regression was carried out to identify the factors that affect the receipt of radiation therapy. We also plotted the overall use of RT over time juxtaposed with the temporal trends of CALGB 9343 clinical trial data, guideline recommendations, and publishing of long-term survival data.
The study cohort included 25,723 Medicare beneficiaries, of whom 20,328 (79%) received RT and 5395 (21%) did not receive RT. In a multivariate model, the frequency of RT omission increased over time, with those diagnosed in year 2015 being 2.72 times more likely to omit RT compared with those diagnosed in 2004 (95% confidence interval 2.31-3.19).
This study investigated the impact of long-term CALGB 9343 data on clinical practice. The results of this study support results from previous studies, extend the dates of analysis, and indicate that after long-term follow-up of CALGB 9343 data, RT was less used, but overall trends did not dramatically decrease.
癌症和白血病研究组 B（CALGB）9343 试验的结果表明，对于接受保乳手术和辅助内分泌治疗的早期雌激素受体阳性乳腺癌且年龄大于 70 岁的女性，放射治疗（RT）并不能提高生存率。2005 年，指南进行了修改，允许省略 RT；然而，临床实践几乎没有发生变化。本研究旨在确定 CALGB 的长期随访数据是否影响 RT 的应用，并描述接受保乳手术后仍接受 RT 的人群特征。
利用监测、流行病学和最终结果-医疗保险数据库，确定 2004 年至 2015 年期间符合 CALGB 9343 纳入标准的早期乳腺癌诊断的女性。采用多变量逻辑回归确定影响放射治疗的因素。我们还绘制了 RT 的总体使用情况随时间的变化，并将其与 CALGB 9343 临床试验数据、指南建议和长期生存数据发布的时间趋势并列。
该研究队列包括 25723 名 Medicare 受益人，其中 20328 人（79%）接受了 RT，5395 人（21%）未接受 RT。在多变量模型中，RT 省略的频率随时间增加，2015 年诊断的患者与 2004 年诊断的患者相比，省略 RT 的可能性增加了 2.72 倍（95%置信区间 2.31-3.19）。
本研究调查了 CALGB 9343 长期数据对临床实践的影响。本研究结果支持之前研究的结果，扩展了分析日期，并表明在 CALGB 9343 数据的长期随访后，RT 的使用减少，但总体趋势没有显著下降。
