Department of Public Health Sciences, University of Chicago, Chicago, Illinois.
Department of Public Health Sciences, University of Chicago, Chicago, Illinois; Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois.
Pract Radiat Oncol. 2024 Sep-Oct;14(5):e305-e323. doi: 10.1016/j.prro.2024.04.010. Epub 2024 Apr 27.
We aimed to update the trend of hypofractionated whole-breast irradiation (HF-WBI) use over time in the US and examine factors associated with lack of HF-WBI adoption for patients with early-stage invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) undergoing a lumpectomy.
Among patients who underwent a lumpectomy, we identified 928,034 patients with early-stage IBC and 330,964 patients with DCIS in the 2004 to 2020 National Cancer Database. We defined HF-WBI as 2.5-3.33 Gy/fraction to the breast and conventionally fractionated WBI as 1.8-2.0 Gy/fraction. We evaluated the trend of HF-WBI utilization using a generalized linear model with the log link and binomial distribution. Factors associated with HF-WBI utilization were assessed using multivariable logistic regression in patients diagnosed between 2018 and 2020.
Among patients with IBC, HF-WBI use has significantly increased from 0.7% in 2004 to 63.9% in 2020. Similarly, HF-WBI usage among patients with DCIS has also increased significantly from 0.4% in 2004 to 56.6% in 2020. Black patients with IBC were less likely than White patients to receive HF-WBI (adjusted odds ratio [AOR] 0.81; 95% CI, 0.77-0.85). Community cancer programs were less likely to administer HF-WBI to patients with IBC (AOR, 0.80; 95% CI, 0.77-0.84) and to those with DCIS (AOR, 0.87; 95% CI, 0.79-0.96) than academic/research programs. Younger age, positive nodes, larger tumor size, low volume programs, and facility location were also associated with lack of HF-WBI adoption in both patient cohorts.
HF-WBI utilization among postlumpectomy patients has significantly increased from 2004 to 2020 and can finally be considered standard of care in the US. We found substantial disparities in adoption within patient and facility subgroups. Reducing disparities in HF-WBI adoption has the potential to further alleviate health care costs while improving patients' quality of life.
本研究旨在更新美国范围内部分乳腺癌患者接受大分割全乳放疗（HF-WBI）治疗的趋势，并分析影响早期浸润性乳腺癌（IBC）或导管原位癌（DCIS）患者行保乳术后接受 HF-WBI 治疗的因素。
本研究纳入了 2004 年至 2020 年间在国家癌症数据库中接受保乳术的 928034 例 IBC 患者和 330964 例 DCIS 患者。我们将 2.5-3.33Gy/次的分割剂量定义为 HF-WBI，将 1.8-2.0Gy/次的分割剂量定义为常规分割 WBI。采用对数链接和二项分布的广义线性模型评估 HF-WBI 使用率的趋势。采用多变量逻辑回归分析评估 2018 年至 2020 年间确诊患者的 HF-WBI 使用率相关因素。
IBC 患者中，HF-WBI 的使用率从 2004 年的 0.7%显著增加至 2020 年的 63.9%。同样，DCIS 患者中 HF-WBI 的使用率也从 2004 年的 0.4%显著增加至 2020 年的 56.6%。与白人患者相比，黑人 IBC 患者接受 HF-WBI 的可能性更低（校正比值比[OR]0.81；95%CI，0.77-0.85）。社区癌症项目为 IBC 患者（OR，0.80；95%CI，0.77-0.84）和 DCIS 患者（OR，0.87；95%CI，0.79-0.96）提供 HF-WBI 的可能性也低于学术/研究项目。在这两个患者队列中，年龄较轻、有阳性淋巴结、肿瘤较大、体积较小的肿瘤以及设施位置也与未采用 HF-WBI 治疗相关。
2004 年至 2020 年间，保乳术后患者接受 HF-WBI 的比例显著增加，最终可被视为美国的标准治疗方法。我们发现，在患者和医疗机构亚组中，HF-WBI 的应用存在显著差异。减少 HF-WBI 应用中的差异有可能进一步降低医疗保健成本，同时提高患者的生活质量。
