Choosing Wisely? Patterns and Correlates of the Use of Hypofractionated Whole-Breast Radiation Therapy in the State of Michigan
Choosing Wisely? Patterns and Correlates of the Use of Hypofractionated Whole-Breast Radiation Therapy in the State of Michigan
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DOI：
10.1016/j.ijrobp.2014.09.027
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发表时间：
2014-12-01
影响因子：
7
通讯作者：
Pierce, Lori J.
中科院分区：
文献类型：
--
作者：
Jagsi, Reshma;Griffith, Kent A.;Pierce, Lori J.
目的：随机试验的证据表明，在选择的接受乳房肿瘤切除术的乳腺癌患者中，更方便、更便宜的大分割放疗疗程与全乳房放疗相比具有非劣效性，我们试图调查大分割放疗的使用及其在密歇根州放射肿瘤学实践联盟中使用的相关因素。我们试图确定在医生或实践水平上发生的使用变化的程度与基于潜在相关患者特征的使用反映个体化的程度方法和材料：我们在一个多水平模型中评估了接受大分割放射治疗与各种患者、提供者和实践特征之间的关系。在2011年10月至2013年1 - 2月接受乳房肿瘤切除术和全乳房放射治疗并由密歇根放射肿瘤质量联盟（MROQC）登记的1477例患者中，913例患有T1-2，N 0乳腺癌。在这913例患者中，283例（31%）接受了大分割放射治疗。在13个实践中，低分割放射治疗的使用范围从2%到80%。在多层次分析中，51%的低分割率变化归因于实践水平，21%归因于提供者水平，28%归因于患者水平。在多变量分析中，低分割在年龄较大的患者中更可能发生（年龄≥ 50岁的比值比[OR] 2.16，P= 0.007），在体型较大的患者中不太可能发生（如果切线入口和出口之间的距离>= 25 cm，OR 0.52，P= 0.002），并且更可能没有接受化疗（OR 3.82，P = 0.001）。
Purpose: Given evidence from randomized trials that have established the non-inferiority of more convenient and less costly courses of hypofractionated radiotherapy to the whole breast in selected breast cancer patients who receive lumpectomy, we sought to investigate the use of hypofractionated radiation therapy and factors associated with its use in a consortium of radiation oncology practices in Michigan. We sought to determine the extent to which variation in use occurs at the physician or practice level versus the extent to which use reflects individualization based on potentially relevant patient characteristics (such as habitus, age, chemotherapy receipt, or laterality).Methods and Materials: We evaluated associations between receipt of hypofractionated radiation therapy and various patient, provider, and practice characteristics in a multilevel model.Results: Of 1477 patients who received lumpectomy and whole-breast radiation therapy and were registered by the Michigan Radiation Oncology Quality Consortium (MROQC) from October 2011 to December 2013, 913 had T1-2, N0 breast cancer. Of these 913, 283 (31%) received hypofractionated radiation therapy. Among the 13 practices, hypofractionated radiation therapy use ranged from 2% to 80%. On multilevel analysis, 51% of the variation in the rate of hypofractionation was attributable to the practice level, 21% to the provider level, and 28% to the patient level. On multivariable analysis, hypofractionation was more likely in patients who were older (odds ratio [OR] 2.16 for age >= 50 years, P=.007), less likely in those with larger body habitus (OR 0.52 if separation between tangent entry and exit >= 25 cm, P=.002), and more likely without chemotherapy receipt (OR 3.82, P