Swanick Cameron W, Jiang Jing, Maldonado J Alberto, Lei Xiudong, Shih Ya-Chen Tina, Caudle Abigail S, Baumann Donald P, Giordano Sharon H, Shaitelman Simona F, Shirvani Shervin M, Smith Benjamin D
Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, Fla.
University of Texas Medical Branch, Galveston, Tex.
Plast Reconstr Surg Glob Open. 2021 Nov 4;9(11):e3904. doi: 10.1097/GOX.0000000000003904. eCollection 2021 Nov.
"Time burden" (time required during treatment) is relevant when choosing a local therapy option for early-stage breast cancer but has not been rigorously studied. We compared the time burden for three common local therapies for breast cancer: (1) lumpectomy plus whole-breast irradiation (Lump+WBI), (2) mastectomy without radiation or reconstruction (Mast alone), and (3) mastectomy without radiation but with reconstruction (Mast+Recon).
Using the MarketScan database, we identified 35,406 breast cancer patients treated from 2000 to 2011 with these local therapies. We quantified the total time burden as the sum of inpatient days (inpatient-days), outpatient days excluding radiation fractions (outpatient-days), and radiation fractions (radiation-days) in the first two years postdiagnosis. Multivariable regression evaluated the effect of local therapy on inpatient-days and outpatient-days adjusted for patient and treatment covariates.
Adjusted mean number of inpatient-days was 1.0 for Lump+WBI, 2.0 for Mast alone, and 3.1 for Mast+Recon ( < 0.001). Adjusted mean number of outpatient-days was 42.9 for Lump+WBI, 42.2 for Mast alone, and 45.8 for Mast+Recon ( < 0.001). The mean number of radiation-days for Lump+WBI was 32.4. Compared with Mast+Recon (48.9 days), total adjusted time burden was 4.7 days shorter for Mast alone (44.2 days) and 27.4 days longer for Lump+WBI (76.3 days). However, use of a 15 fraction WBI regimen would reduce the time burden differential between Lump+WBI and Mast+Recon to just 10.0 days.
Although Mast+Recon confers the highest inpatient and outpatient time burden, Lump+WBI carries the highest total time burden. Increased use of hypofractionation will reduce the total time burden for Lump+WBI.
在为早期乳腺癌选择局部治疗方案时，“时间负担”（治疗期间所需时间）是一个相关因素，但尚未得到严格研究。我们比较了三种常见的乳腺癌局部治疗的时间负担：（1）保乳手术加全乳照射（保乳手术+全乳照射），（2）单纯乳房切除术（不进行放疗或重建），以及（3）单纯乳房切除术（不进行放疗但进行重建）。
利用MarketScan数据库，我们确定了2000年至2011年接受这些局部治疗的35406例乳腺癌患者。我们将总时间负担量化为诊断后前两年的住院天数、不包括放疗次数的门诊天数和放疗次数之和。多变量回归评估了局部治疗对住院天数和门诊天数的影响，并对患者和治疗协变量进行了调整。
保乳手术+全乳照射的调整后平均住院天数为1.0天，单纯乳房切除术为2.0天，乳房切除术+重建为3.1天（<0.001）。保乳手术+全乳照射的调整后平均门诊天数为42.9天，单纯乳房切除术为42.2天，乳房切除术+重建为45.8天（<0.001）。保乳手术+全乳照射的平均放疗天数为32.4天。与乳房切除术+重建（48.9天）相比，单纯乳房切除术的调整后总时间负担短4.7天（44.2天），保乳手术+全乳照射长27.4天（76.3天）。然而，采用15次分割的全乳照射方案将使保乳手术+全乳照射与乳房切除术+重建之间的时间负担差异仅降至10.0天。
虽然乳房切除术+重建带来的住院和门诊时间负担最高，但保乳手术+全乳照射的总时间负担最高。增加使用低分割放疗将减少保乳手术+全乳照射的总时间负担。
