Radiotherapy Trends and Variations in Invasive Non-metastatic Breast Cancer Treatment in the Netherlands: A Nationwide Overview From 2008 to 2019

被引:1
作者
Evers, J. [1 ,2 ]
van der Sangen, M. J. C. [3 ]
van Maaren, M. C. [1 ,2 ]
Maduro, J. H. [4 ]
Strobbe, L. [5 ]
Aarts, M. J. [1 ]
Bloemers, M. C. W. M. [6 ]
van den Bongard, D. H. J. G. [7 ]
Struikmans, H. [2 ,8 ]
Siesling, S. [2 ]
机构
[1] Netherlands Comprehens Canc Org IKNL, Dept Res & Dev, POB 19079, NL-3501 DB Utrecht, Netherlands
[2] Univ Twente, Tech Med Ctr, Dept Hlth Technol & Serv Res, Hallenweg 5, NL-7522 NH Enschede, Netherlands
[3] Catharina Hosp, Dept Radiat Oncol, Michelangelolaan 2, NL-5623 EJ Eindhoven, Netherlands
[4] Univ Groningen, Univ Med Ctr Groningen, Dept Radiat Oncol, Hanzeplein 1, NL-9713 GZ Groningen, Netherlands
[5] Canisius Wilhelmina Hosp, Dept Surg, Weg Door Jonkerbos 100, NL-6532 SZ Nijmegen, Netherlands
[6] Netherlands Canc Inst, Dept Radiat Oncol, Plesmanlaan 121, NL-1066 CX Amsterdam, Netherlands
[7] Univ Amsterdam, Med Ctr, Dept Radiat Oncol, Boelelaan 1117, NL-1081 HV Amsterdam, Netherlands
[8] Leiden Univ, Med Ctr, Dept Radiat Oncol, Albinusdreef 2, NL-2333 ZA Leiden, Netherlands
关键词
axillary radiotherapy; boost irradiation; breast-conserving therapy; epidemiology; non-metastatic breast cancer; radiotherapy; TERM-FOLLOW-UP; CONSERVING SURGERY; POSTMASTECTOMY RADIOTHERAPY; RADIATION ONCOLOGY; AMERICAN SOCIETY; EORTC BOOST; IN-SITU; IRRADIATION; PHASE-3; WOMEN;
D O I
10.1016/j.clon.2024.08.010
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Aims: This nationwide study provides an overview of trends and variations in radiotherapy use as part of multimodal treatment of invasive non-metastatic breast cancer in the Netherlands in 2008-2019. Materials and Methods: Women with invasive non-metastatic breast cancer were selected from the population-based Netherlands Cancer Registry. Treatments trends were presented over time. Factors associated with (1) boost irradiation in breast-conserving therapy and (2) regional radiotherapy instead of axillary lymph node dissection (ALND) in N+ disease were identified using multilevel logistic regression analyses. Results: Radiotherapy use increased from 61% (2008) to 70% (2016), caused by breast-conserving therapy instead of mastectomy, increased post-mastectomy radiotherapy, and increased regional radiotherapy (32% in 2011 to 61% in 2019) instead of ALND in N+ disease. Omission of radiotherapy after breast-conserving surgery (BCS) in 2016-2019 (4-9%, respectively), mainly in elderly, decreased overall radiotherapy use to 67%. Radiotherapy treatment was further de-escalated by decreased boost irradiation in breast-conserving therapy (66% in 2011 to 37% in 2019) and partial (1% in 2011 to 6% in 2019) instead of whole breast irradiation following BCS. Boost irradiation was associated with high-risk features: younger age (OR>75 vs <50:0.04, 95%CI:0.03-0.05), higher grade (OR grade III vs I:11.46, 95% CI:9.90-13.26) and residual disease (OR focal residual vs R0-resection:28.08, 95%CI:23.07-34.17). Variation across the country was found for both boost irradiation use (OR South vs North:0.58, 95%CI:0.49-0.68), and regional radiotherapy instead of ALND (OR Southwest vs North:0.55, 95%CI:0.37-0.80). Conclusion: Overall radiotherapy use increased in 2008-2016, while a decreasing trend was observed after 2016, caused by post-BCS radiotherapy omission. Boost irradiation in breast-conserving therapy became omitted in low-risk patients, and regional radiotherapy use increased as an alternative for ALND in N+ disease. (c) 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
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收藏
页码:765 / 779
页数:15
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