Correlates and Effect of Suboptimal Radiotherapy in Women With Ductal Carcinoma In Situ or Early Invasive Breast Cancer
Correlates and Effect of Suboptimal Radiotherapy in Women With Ductal Carcinoma In Situ or Early Invasive Breast Cancer
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DOI：
10.1002/cncr.23923
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发表时间：
2008-12-01
期刊：
影响因子：
6.2
通讯作者：
Dick, Andrew W.
中科院分区：
文献类型：
--
作者：
Gold, Heather Taffet;Do, Huong T.;Dick, Andrew W.
背景。该研究旨在确定与非最佳放疗（RT）相关的因素及其对66岁以上诊断为I期乳腺癌或导管原位癌（DCIS）的女性无病生存的影响。研究对象是1991年至1999年在相关的监测、流行病学和最终结果(SEER)-Medicare数据库中诊断的女性，她们在诊断后12个月内接受了保乳手术和RT。作者进行了描述性和多变量生存分析，并考虑了年龄、种族、贫困、婚姻状况、合并症指标、农村/城市、放射肿瘤学家密度、comedo坏死组织学（仅DCIS）、化疗接受情况（仅I期）、RT完成（治疗3+周）和延迟（术后8+周未化疗；化疗4+周）。在7791名受试者中，16%经历了放疗延迟，3%经历了不完全放疗。I期疾病受试者更有可能延迟放疗的是黑人（优势比[OR]， 1.56； 95%可信区间[CI]， 1.17-2.08），而生活在高放射肿瘤学家密度地区的女性延迟放疗的可能性较小（OR, 0.73; 95% CI, 0.66-0.81）。生活在高度贫困地区的患者完成放疗的可能性较低（P < .03），接受化疗的患者也是如此（OR, 1.82; 95% CI, 1.15-2.88）。延迟放疗的I期乳腺癌患者更有可能经历随后的乳房事件（OR, 1.14; 95% CI, 1.00-1.30），而不完全放疗的患者总死亡率更高（OR, 1.32; 95% CI, 1.06-1.63）。与较低的后续乳房事件相关的因素包括年龄较大，化疗后12周以上（或8周以上）的RT延迟对后续事件有强烈的负面影响（DCIS or为3.94；95% CI为2.51-6.17；I期or为2.77；95% CI为1.84-2.59）。对于早期浸润性乳腺癌患者，应促进RT的完成和及时性。癌症2008;113:3108-15。(C) 2008年美国癌症协会。
BACKGROUND. The study aimed to identify factors associated with less-than-optimal radiotherapy (RT) and its impact on disease-free survival in women aged 66+ years diagnosed with stage I breast cancer or ductal carcinoma in situ (DCIS).METHODS. The subjects were women diagnosed from 1991 to 1999 in the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database who underwent breast-conserving surgery and RT within 12 months postdiagnosis. The authors conducted descriptive and multivariate survival analyses, and considered age, race, poverty, marital status, comorbidity indices, rural/urban, radiation oncologist density, comedo necrosis histology (DCIS only), chemotherapy receipt (stage I only), and RT completion (3+ weeks of treatment) and delay (8+ weeks postsurgery without chemotherapy; 4+ weeks postchemotherapy).RESULTS. Of 7791 subjects, 16% experienced RT delay, and 3% had incomplete RT. Subjects with stage I disease who were more likely to delay RT were of black race (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.17-2.08), whereas women in areas of high radiation oncologist density were less likely to delay (OR, 0.73; 95% CI, 0.66-0.81). Those living in high poverty areas were less likely to complete RT (P < .03), as were those undergoing chemotherapy (OR, 1.82; 95% CI, 1.15-2.88). Stage I breast cancer patients with delayed RT were more likely to experience a subsequent breast event (OR, 1.14; 95% CI, 1.00-1.30), and those with incomplete RT had a higher rate of overall mortality (OR, 1.32; 95% CI, 1.06-1.63). Factors associated with lower subsequent breast events included older age, RT delays of 12+ weeks (or 8+ weeks postchemotherapy) had a strongly negative impact on subsequent events (OR, 3.94; 95% CI, 2.51-6.17 for DCIS; OR, 2.77; 95% CI, 1.84-2.59 for stage I).CONCLUSIONS. RT should be facilitated to ensure completion and timeliness, especially for early invasive breast cancer patients. Cancer 2008;113:3108-15. (C) 2008 American Cancer Society.