Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery
Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery
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DOI：
10.1093/jnci/92.3.269
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发表时间：
2000-02-02
期刊：
影响因子：
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通讯作者：
Key, CR
中科院分区：
文献类型：
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作者：
Athas, WF;Adams-Cameron, M;Key, CR
对于早期乳腺癌女性来说，保乳手术（BCS）加放射治疗是乳房切除术的有效替代治疗方法（1，2）。然而，15%-30%接受BCS治疗早期疾病的女性未能接受术后乳房放疗，尽管已知与遗漏放疗相关的同侧复发风险增加（3-8）。年龄较大已被确定为BCS后不接受放疗的主要决定因素（4，6，7，9）。其他可能导致无法接受放射治疗的因素，特别是在年轻女性中，仍有待确定。到放射治疗机构的距离可能会影响术后乳房照射的接受。BCS后的放射治疗通常包括连续5-6周的每日治疗（周末除外）。长途旅行的必要性可能会增加放射治疗的不便或成本，以至于根本不可能接受治疗。20世纪80年代中后期在西雅图-普吉特海湾地区进行的一项乳腺癌治疗研究发现，生活在没有放射治疗设施的县与BCS后接受放射治疗的可能性降低50%相关（4）。在新墨西哥州进行的一项类似的同期研究（3）发现放疗与旅行距离之间没有关系，但分析仅限于手动识别未接受放疗的BCS患者的地理聚集。在这项研究中，我们使用了地理信息系统（GIS）来测量患者到放射治疗设施的实际旅行距离，以更精确地检查BCS后旅行距离和接受放射治疗之间的关系。
Breast-conserving surgery (BCS) followed by radiation therapy is an efficacious alternative treatment to mastectomy for women with early-stage breast cancer (1, 2). However, 15%–30% of the women treated with BCS for early-stage disease fail to undergo postoperative breast irradiation, despite the known increased risk of ipsilateral recurrence associated with the omission of radiotherapy (3–8). Older age has been identified as a major determinant of not receiving radiotherapy after BCS (4, 6, 7, 9). Other factors that could account for failure to receive radiation therapy, particularly among younger women, remain to be identified. Travel distance to a radiationtreatment facility may influence the receipt of postoperative breast irradiation.Radiotherapy that follows BCS typically involves daily treatments (weekends excluded), for a period of 5–6 consecutive weeks. The necessity of long-distance travel may increase the inconvenience or cost of radiotherapy to a point where it simply is not feasible to receive treatment. A study of breast cancer treatment conducted in the mid-to late-1980s in the Seattle–Puget Sound area found that living in a county without a radiationtreatment facility was associated with a 50% lower likelihood of receiving radiotherapy after BCS (4). A similar contemporaneous study in New Mexico (3) found no relationship between radiotherapy and travel distance, but the analysis was limited to manual identification of geographic clustering of BCS patients not receiving radiotherapy. In this study, we used a geographic information system (GIS) to measure actual patient travel distances to radiationtreatment facilities to more precisely examine the relationship between travel distance and receipt of radiotherapy after BCS.