Incidence and predictors of low dose-intensity in adjuvant breast cancer chemotherapy: A nationwide study of community practices
Incidence and predictors of low dose-intensity in adjuvant breast cancer chemotherapy: A nationwide study of community practices
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DOI：
10.1200/jco.2003.05.002
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发表时间：
2003-12-15
影响因子：
45.3
通讯作者：
Crawford, J
中科院分区：
文献类型：
--
作者：
Lyman, GH;Dale, DC;Crawford, J
目的：本回顾性研究旨在评估早期乳腺癌（ESBC）辅助化疗的实践模式，并确定相对剂量强度降低（RDI）的发病率和预测因素。患者和方法：对1,243例社区肿瘤学实践进行了全国性调查，数据来自20,799例ESBC患者接受辅助化疗的记录。评估包括人口统计学和临床特征、化疗剂量调整、发热性中性粒细胞减少症的发生率和集落刺激因子（CSF）的使用模式。结果：36.5%的患者剂量减少≥ 15%，24.9%的患者治疗延迟> 7天，导致55.5%的患者RDI <85%。当调整方案剂量强度差异时，近三分之二的患者接受的RDI低于85%。多变量分析确定了RDI降低的几个独立预测因素，包括年龄增加;环磷酰胺、甲氨蝶呤和氟尿嘧啶或环磷酰胺、多柔比星和氟尿嘧啶化疗; 28天的治疗计划;体表面积大于2 m2;以及没有初级CSF预防。CSF往往是在化疗cycle.Conclusion晚开始：ESBC患者在接受辅助化疗时，RDI降低的风险很大。风险最大的患者包括老年患者，超重患者和接受三种药物组合或28天计划的患者。基于这些风险因素的预测模型应该能够选择性地应用支持性措施，以提供完全的近强度化疗。(C)2003年，美国临床肿瘤学会。
Purpose: This retrospective study was undertaken to assess practice patterns in adjuvant chemotherapy for early-stage breast cancer (ESBC) and to define the incidence and predictive factors of reduced relative dose-intensity (RDI).Patients and Methods: A nationwide survey of 1,243 community oncology practices was conducted, with data extracted from records of 20,799 ESBC patients treated with adjuvant chemotherapy. Assessments included demographic and clinical characteristics, chemotherapy dose modifications, incidence of febrile neutropenia, and patterns of use of colony-stimulating factor (CSF). Dose-intensity was compared with published reference standard regimens.Results: Dose reductions greater than or equal to15% occurred in 36.5% of patients, and there were treatment delays 7 days in 24.9% of patients, resulting in 55.5% of patients receiving RDI less than 85%. Nearly two thirds of patients received RDI less than 85% when adjusted for differences in regimen dose-intensity. Multivariate analysis identified several independent predictors for reduced RDI, including increased age; chemotherapy with cyclophosphamide, methotrexate, and fluorouracil, or cyclophosphamide, doxorubicin, and fluorouracil; a 28-day schedule; body-surface area greater than 2 m(2); and no primary CSF prophylaxis. CSF was often initiated late in the chemotherapy cycle.Conclusion: Patients with ESBC are at substantial risk for reduced RDI when treated with adjuvant chemotherapy. Patients at greatest risk include older patients, overweight patients, and those receiving three-drug combinations or 28-day schedules. Predictive models based on such risk factors should enable the selective application of supportive measures in an effort to deliver full close-intensity chemotherapy. (C) 2003 by American Society of Clinical Oncology.