In a recent study published in International Journal of Radiation Oncology • Biology • Physics (Red Journal), a group of researchers found that treatment with hypofractionated whole-breast irradiation (HF-WBI) for patients suffering with early-stage breast cancer has significantly increased in the time period between 2004 and 2011. Furthermore, HF-WBI is more frequently used than conventional fractionated whole-breast irradiation (CF-WBI) in patients who undergo treatment at an academic center or live further away from a cancer center.
This study, titled “Adoption of Hypofractionated Whole-Breast Irradiation for Early-Stage Breast Cancer: A National Cancer Data Base Analysis,” reviewed data from 113,267 early-stage breast cancer patients present in the National Cancer Data Base (NCDB) from 2004 to 2011. These patients had received radiation therapy, were older than 50 years of age, had breast-conserving surgery, did not receive chemotherapy and were suitable to receive HF-WBI.
The study compared the use of HF-WBI to CF-WBI, along with the different factors such as type of facility and the distance form the treatment center to a patient’s house, that could be of influence in the choice of WBI.
Researchers found that among the total number of patients, 11.7% received HF-WBI, while 88.3% received CF-WBI. In 2004, there were only 5.4% of patients who received HF-WBI, compared to a significant increase to 22.8% in 2011. Nonetheless, the majority of patients were still prescribed CF-WBI with a total of 94.6% and 77.2% of patients receiving CF-WBI in 2004 and 2011, respectively.
Furthermore, researchers observed that 62.5% of patients received treatment at a non-academic comprehensive community cancer center; 24.8% attended a community cancer program; 11.6% were treated at an academic center; and 1.0% was treated at other types of facilities.
Of the patients receiving treatment at non-academic comprehensive community cancer centers, 10.3% underwent HF-WBI, versus 17.3% of those who received treatment at academic centers.
Additionally, the distance from the cancer-reporting facility to the radiation therapy center also played an important role in the type of treatment received.
As such, the authors found that patients who lived more than 50 miles away from the treatment center were more commonly prescribed HF-WBI than those who lived closer.
“Recently reported, long-term follow-up from randomized trials confirm that hypofractionated radiation therapy for breast cancer is equivalent to longer courses of radiation therapy. As a result, recent clinical guidelines such as ASTRO’s “Fractionation for whole-breast irradiation: An American Society for Radiation Oncology (ASTRO) evidence-based guideline” and ASTRO’s Choosing Wisely® recommendations support the use of hypofractionated radiation therapy for breast cancer,” James B. Yu, MD, MHS, co-author of the study and assistant professor in the Department of Therapeutic Radiology at Yale School of Medicine in New Haven, Connecticut, said in an ASTRO press release. “This study demonstrates that many physicians are focused on providing high-quality treatment that is cost-effective and convenient for patients even prior to these guidelines. At the same time, the results suggest that more education on guideline recommendations and clinical trial results would be beneficial for those physicians who may be hesitant to prescribe hypofractionated radiation therapy for appropriate patients”.
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