Skip to main content
Erschienen in: Annals of Surgical Oncology 13/2014

01.12.2014 | Breast Oncology

Increased Use of Partial-Breast Irradiation Has Not Improved Radiotherapy Utilization for Early-Stage Breast Cancer

verfasst von: Julie A. Billar, MD, Myung Shin Sim, DrPH, Maureen Chung, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 13/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Radiotherapy (RT) reduces local recurrence after breast-conserving surgery (BCS) for breast cancer, but under-utilization of RT has been reported. Accelerated partial-breast irradiation (PBI) improves RT accessibility, but it is uncertain if this has improved RT utilization.

Methods

The Surveillance, Epidemiology and End Results registry was used to identify women who underwent BCS for stage 0 or 1 breast cancer from 2000 to 2009. Temporal trends in RT utilization and RT modality were determined. Chi-square analysis and multivariate logistic regression identified predictors of RT utilization and modality.

Results

Of 180,219 study patients, 131,343 (73 %) received RT; 123,703 (94 %) of RT recipients received whole-breast irradiation (WBI) and 6,251 (5 %) received PBI. PBI rates increased dramatically during the study period (0.32 % in 2000 vs. 6.5 % in 2009), but overall RT utilization remained relatively stable because of a decline in WBI (69.8 % in 2000 vs. 62.4 % in 2009). RT utilization was unchanged in rural counties, and declined for women <40 and ≥70 years of age, and for Native American, Asian and Hispanic patients. White and Black women used PBI most frequently (4 % each) and were the only race groups with improved RT utilization over time. Predictors of RT usage included age, race, marital status, tumor size, grade, hormone receptor status, lymph node evaluation, geographic region, metropolitan status, education, and employment status.

Conclusions

Women who undergo RT are opting for PBI more frequently, but the increased use of this modality has not improved overall RT utilization for patients with early-stage breast cancer.
Literatur
1.
Zurück zum Zitat Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.PubMedCrossRef Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.PubMedCrossRef
2.
Zurück zum Zitat Viani GA, Stefano EJ, Afonso SL, et al. Breast-conserving surgery with or without radiotherapy in women with ductal carcinoma in situ: a meta-analysis of randomized trials. Radiat Oncol. 2007;2:28.PubMedCentralPubMedCrossRef Viani GA, Stefano EJ, Afonso SL, et al. Breast-conserving surgery with or without radiotherapy in women with ductal carcinoma in situ: a meta-analysis of randomized trials. Radiat Oncol. 2007;2:28.PubMedCentralPubMedCrossRef
3.
Zurück zum Zitat Nattinger AB, Kneusel RT, Hoffmann RG, Gilligan MA. Relationship of distance from a radiotherapy facility and initial breast cancer treatment. J Natl Cancer Inst. 2001;93:1344–6.PubMedCrossRef Nattinger AB, Kneusel RT, Hoffmann RG, Gilligan MA. Relationship of distance from a radiotherapy facility and initial breast cancer treatment. J Natl Cancer Inst. 2001;93:1344–6.PubMedCrossRef
4.
Zurück zum Zitat Buchholz TA, Theriault RL, Niland JC, et al. The use of radiation as a component of breast conservation therapy in National Comprehensive Cancer Network Centers. J Clin Oncol. 2006;24:361–9.PubMedCrossRef Buchholz TA, Theriault RL, Niland JC, et al. The use of radiation as a component of breast conservation therapy in National Comprehensive Cancer Network Centers. J Clin Oncol. 2006;24:361–9.PubMedCrossRef
5.
Zurück zum Zitat Martinez SR, Shah DR, Tseng WH, Canter RJ, Bold RJ. Rural-urban disparities in use of post-lumpectomy radiation. Med Oncol. 2012;29:3250–7.PubMedCrossRef Martinez SR, Shah DR, Tseng WH, Canter RJ, Bold RJ. Rural-urban disparities in use of post-lumpectomy radiation. Med Oncol. 2012;29:3250–7.PubMedCrossRef
6.
Zurück zum Zitat Tuttle TM, Jarosek S, Habermann EB, Yee D, Yuan J, Virnig BA. Omission of radiation therapy after breast-conserving surgery in the United States: a population-based analysis of clinicopathologic factors. Cancer. 2012;118:2004–13.PubMedCrossRef Tuttle TM, Jarosek S, Habermann EB, Yee D, Yuan J, Virnig BA. Omission of radiation therapy after breast-conserving surgery in the United States: a population-based analysis of clinicopathologic factors. Cancer. 2012;118:2004–13.PubMedCrossRef
7.
Zurück zum Zitat Soulos PR, Yu JB, Roberts KB, et al. Assessing the impact of a cooperative group trial on breast cancer care in the medicare population. J Clin Oncol. 2012;30:1601–7.PubMedCentralPubMedCrossRef Soulos PR, Yu JB, Roberts KB, et al. Assessing the impact of a cooperative group trial on breast cancer care in the medicare population. J Clin Oncol. 2012;30:1601–7.PubMedCentralPubMedCrossRef
8.
Zurück zum Zitat Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2004;96:443–8.PubMedCrossRef Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2004;96:443–8.PubMedCrossRef
9.
Zurück zum Zitat Smith GL, Shih YC, Xu Y, et al. Racial disparities in the use of radiotherapy after breast-conserving surgery: a national Medicare study. Cancer. 2010;116:734–41.PubMedCrossRef Smith GL, Shih YC, Xu Y, et al. Racial disparities in the use of radiotherapy after breast-conserving surgery: a national Medicare study. Cancer. 2010;116:734–41.PubMedCrossRef
10.
Zurück zum Zitat Smith GL, Xu Y, Buchholz TA, et al. Brachytherapy for accelerated partial-breast irradiation: a rapidly emerging technology in breast cancer care. J Clin Oncol. 2010;29:157–65.PubMedCrossRef Smith GL, Xu Y, Buchholz TA, et al. Brachytherapy for accelerated partial-breast irradiation: a rapidly emerging technology in breast cancer care. J Clin Oncol. 2010;29:157–65.PubMedCrossRef
11.
Zurück zum Zitat Smith GL, Xu Y, Buchholz TA, et al. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA. 2012;307:1827–37.PubMedCentralPubMed Smith GL, Xu Y, Buchholz TA, et al. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA. 2012;307:1827–37.PubMedCentralPubMed
12.
Zurück zum Zitat Abbott AM, Habermann EB, Tuttle TM. Trends in the use of implantable accelerated partial breast irradiation therapy for early stage breast cancer in the United States. Cancer. 2011;117:3305–10.PubMedCrossRef Abbott AM, Habermann EB, Tuttle TM. Trends in the use of implantable accelerated partial breast irradiation therapy for early stage breast cancer in the United States. Cancer. 2011;117:3305–10.PubMedCrossRef
13.
Zurück zum Zitat Hattangadi JA, Taback N, Neville BA, Harris JR, Punglia RS. Accelerated partial breast irradiation using brachytherapy for breast cancer: patterns in utilization and guideline concordance. J Natl Cancer Inst. 2011;104:29–41.PubMedCrossRef Hattangadi JA, Taback N, Neville BA, Harris JR, Punglia RS. Accelerated partial breast irradiation using brachytherapy for breast cancer: patterns in utilization and guideline concordance. J Natl Cancer Inst. 2011;104:29–41.PubMedCrossRef
14.
Zurück zum Zitat Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001.PubMedCrossRef Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001.PubMedCrossRef
15.
Zurück zum Zitat Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004;351:971–7.PubMedCrossRef Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004;351:971–7.PubMedCrossRef
16.
Zurück zum Zitat Miles RC, Gullerud RE, Lohse CM, Jakub JW, Degnim AC, Boughey JC. Local recurrence after breast-conserving surgery: multivariable analysis of risk factors and the impact of young age. Ann Surg Oncol. 2012;19:1153–9.PubMedCrossRef Miles RC, Gullerud RE, Lohse CM, Jakub JW, Degnim AC, Boughey JC. Local recurrence after breast-conserving surgery: multivariable analysis of risk factors and the impact of young age. Ann Surg Oncol. 2012;19:1153–9.PubMedCrossRef
17.
Zurück zum Zitat Walker GV, Giordano SH, Williams M, et al. Muddy water? Variation in reporting receipt of breast cancer radiation therapy by population-based tumor registries. Int J Radiat Oncol Biol Phys. 2013;86:686–93.PubMedCrossRef Walker GV, Giordano SH, Williams M, et al. Muddy water? Variation in reporting receipt of breast cancer radiation therapy by population-based tumor registries. Int J Radiat Oncol Biol Phys. 2013;86:686–93.PubMedCrossRef
18.
Zurück zum Zitat Jaqsi R, Abrahamse P, Hawley ST, Graff JJ, Hamilton AS, Katz SJ. Underascertainment of radiotherapy receipt in Surveillance, Epidemiology, and End Results registry data. Cancer. 2012;118:333–41.CrossRef Jaqsi R, Abrahamse P, Hawley ST, Graff JJ, Hamilton AS, Katz SJ. Underascertainment of radiotherapy receipt in Surveillance, Epidemiology, and End Results registry data. Cancer. 2012;118:333–41.CrossRef
19.
Zurück zum Zitat Presley CJ, Soulos PR, Herrin J, et al. Patterns of use and short-term complications of breast brachytherapy in the national Medicare population from 2008–2009. J Clin Oncol. 2012;30:4302–7.PubMedCentralPubMedCrossRef Presley CJ, Soulos PR, Herrin J, et al. Patterns of use and short-term complications of breast brachytherapy in the national Medicare population from 2008–2009. J Clin Oncol. 2012;30:4302–7.PubMedCentralPubMedCrossRef
20.
Zurück zum Zitat Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362:513–20.PubMedCrossRef Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362:513–20.PubMedCrossRef
21.
Zurück zum Zitat Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010;376:91–102.PubMedCrossRef Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010;376:91–102.PubMedCrossRef
22.
Zurück zum Zitat Norris D, Julian TB. Update on the NSABP B-39/RTOG 0413 clinical trial. Oncol Iss. 2008;20–1. Norris D, Julian TB. Update on the NSABP B-39/RTOG 0413 clinical trial. Oncol Iss. 2008;20–1.
Metadaten
Titel
Increased Use of Partial-Breast Irradiation Has Not Improved Radiotherapy Utilization for Early-Stage Breast Cancer
verfasst von
Julie A. Billar, MD
Myung Shin Sim, DrPH
Maureen Chung, MD, PhD
Publikationsdatum
01.12.2014
Verlag
Springer US
Erschienen in
Annals of Surgical Oncology / Ausgabe 13/2014
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3867-3

Weitere Artikel der Ausgabe 13/2014

Annals of Surgical Oncology 13/2014 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.