Accelerated Partial Breast Irradiation Using Brachytherapy for Breast Cancer: Patterns in Utilization and Guideline Concordance
Accelerated Partial Breast Irradiation Using Brachytherapy for Breast Cancer: Patterns in Utilization and Guideline Concordance
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DOI：
10.1093/jnci/djr495
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发表时间：
2012-01-01
影响因子：
10.3
通讯作者：
Punglia, Rinaa S.
中科院分区：
文献类型：
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作者：
Hattangadi, Jona A.;Taback, Nathan;Punglia, Rinaa S.
使用近距离加速部分乳房照射（APBIb）是保乳手术后全乳照射（WBI）的替代选择。我们根据2009年美国放射肿瘤学学会共识指南（ASTRO-G）在基于人群的队列中评估了APBIb的使用模式。从监测、流行病学和最终结果数据中，我们确定了2000年1月1日至2007年12月31日期间诊断为乳腺癌的13815名美国妇女，她们在保乳手术后接受了WBI或APBIb，并根据ASTRO-G标准将她们分为适合、警告或不适合APBIb。应用逻辑回归研究APBIb的总体使用情况和每个指南类别的使用情况。所有P值均来自双侧检验。总体而言，2.6%的患者接受了APBIb，其中65.8%的患者被分类为警告或不适合。根据ASTRO-G标准，5%的适宜患者、3.4%的警告患者和1.6%的不适宜患者使用APBIb （P < 0.001）。APBIb的使用从2000年的0.4%增加到2007年的6.6%，各地差异很大（0%-7%）。与合适患者使用APBIb相关的变量包括其他种族与白人（比值比[OR] = 0.51, P < .001）、地区（OR = 2.60-8.62, P < .001）和最近年份（OR = 20.3, P < .001）。在警告性患者中，与APBIb使用相关的变量包括黑人与白人种族（OR = 0.76, P = 0.027）、其他种族与白人种族（OR = 0.57, P < 0.001）、西班牙裔（OR = 0.75, P = 0.036）、地区（OR = 3.10-10.2, P < 0.001）、非大都市或农村地区（OR = 0.53, P = 0.012）和最近年份（OR = 17.6, P < 0.001）。在不适宜患者中，黑人与白人（OR = 0.77, P = 0.008）、其他种族与白人（OR = 0.46, P < 0.001）、地区（OR = 3.33-21.6, P < 0.001）和最近年份（OR = 12.7, P < 0.001）与APBIb使用相关。在美国，保乳手术后的APBIb已被迅速采用。使用情况因种族、民族和地区而异，特别是在可能不适合这种放射技术的患者中。
Accelerated partial breast irradiation using brachytherapy (APBIb) is an alternative to whole-breast irradiation (WBI) after breast-conserving surgery. We evaluated patterns of APBIb use with respect to 2009 American Society for Radiation Oncology consensus guidelines (ASTRO-G) in a population-based cohort.From Surveillance, Epidemiology, and End Results data, we identified 138 815 American women with breast cancer diagnosed between January 1, 2000, and December 31, 2007, who underwent WBI or APBIb after breast-conserving surgery and classified them as suitable, cautionary, or unsuitable for APBIb according to ASTRO-G criteria. Logistic regression was applied to study APBIb use overall and within each guideline category. All P values are from two-sided tests.Overall, 2.6% of patients received APBIb, and 65.8% of them were classified as cautionary or unsuitable. APBIb was used by 5% of suitable, 3.4% of cautionary, and 1.6% of unsuitable patients by ASTRO-G criteria (P < .001). APBIb use increased from 0.4% in 2000 to 6.6% in 2007 and varied widely (0%-7%) between localities. Variables associated with APBIb use among suitable patients included other vs white race (odds ratio [OR] = 0.51, P < .001), region (OR = 2.60-8.62, P < .001), and more recent year (OR = 20.3, P < .001). Among cautionary patients, variables associated with APBIb use included black vs white race (OR = 0.76, P = .027), other vs white race (OR = 0.57, P < .001), Hispanic ethnicity (OR = 0.75, P = .036), region (OR = 3.10-10.2, P < .001), nonmetropolitan or rural location (OR = 0.53, P = .012), and more recent year (OR = 17.6, P < .001). Among unsuitable patients, black vs white race (OR = 0.77, P = .008), other vs white race (OR = 0.46, P < .001), region (OR = 3.33-21.6, P < .001), and more recent year (OR = 12.7, P < .001) were associated with APBIb use.APBIb after breast-conserving surgery has been rapidly adopted in the United States. Use varied by race, ethnicity, and widely by region, especially among patients who may not be suitable for this radiation technique.