Long-term Impact of CALGB 9343 on Radiation Utilization.
Age Factors
Aged
Aged, 80 and over
Breast
/ pathology
Breast Neoplasms
/ mortality
Female
Follow-Up Studies
Humans
Life Expectancy
Mastectomy, Radical
/ statistics & numerical data
Mastectomy, Segmental
/ statistics & numerical data
Medicare
/ statistics & numerical data
Practice Guidelines as Topic
Practice Patterns, Physicians'
/ standards
Radiotherapy, Adjuvant
/ standards
Randomized Controlled Trials as Topic
Receptors, Estrogen
/ metabolism
Reoperation
/ statistics & numerical data
Retrospective Studies
SEER Program
/ statistics & numerical data
Survival Analysis
Treatment Outcome
United States
/ epidemiology
CALGB 9343
Elderly breast cancer
Radiation therapy
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
04
03
2020
revised:
07
07
2020
accepted:
11
07
2020
pubmed:
18
8
2020
medline:
11
3
2021
entrez:
18
8
2020
Statut:
ppublish
Résumé
The results of the Cancer and Leukemia Group B (CALGB) 9343 trial showed that radiation therapy (RT) did not improve survival for women older than 70 y with early-stage estrogen receptor + breast cancer treated with breast conserving surgery and adjuvant endocrine therapy. In 2005, guidelines were modified to allow for RT omission; however, minimal change in clinical practice has occurred. The aim of this study was to determine if CALGB long-term follow-up data have affected RT utilization, and to characterize the population still receiving RT after breast conserving surgery. The Surveillance, Epidemiology, and End Results-Medicare database was used to identify women diagnosed with early-stage breast cancer from 2004 to 2015 who matched the CALGB 9343 inclusion criteria. Multivariate logistic regression was carried out to identify the factors that affect the receipt of radiation therapy. We also plotted the overall use of RT over time juxtaposed with the temporal trends of CALGB 9343 clinical trial data, guideline recommendations, and publishing of long-term survival data. The study cohort included 25,723 Medicare beneficiaries, of whom 20,328 (79%) received RT and 5395 (21%) did not receive RT. In a multivariate model, the frequency of RT omission increased over time, with those diagnosed in year 2015 being 2.72 times more likely to omit RT compared with those diagnosed in 2004 (95% confidence interval 2.31-3.19). This study investigated the impact of long-term CALGB 9343 data on clinical practice. The results of this study support results from previous studies, extend the dates of analysis, and indicate that after long-term follow-up of CALGB 9343 data, RT was less used, but overall trends did not dramatically decrease.
Sections du résumé
BACKGROUND
The results of the Cancer and Leukemia Group B (CALGB) 9343 trial showed that radiation therapy (RT) did not improve survival for women older than 70 y with early-stage estrogen receptor + breast cancer treated with breast conserving surgery and adjuvant endocrine therapy. In 2005, guidelines were modified to allow for RT omission; however, minimal change in clinical practice has occurred. The aim of this study was to determine if CALGB long-term follow-up data have affected RT utilization, and to characterize the population still receiving RT after breast conserving surgery.
METHODS
The Surveillance, Epidemiology, and End Results-Medicare database was used to identify women diagnosed with early-stage breast cancer from 2004 to 2015 who matched the CALGB 9343 inclusion criteria. Multivariate logistic regression was carried out to identify the factors that affect the receipt of radiation therapy. We also plotted the overall use of RT over time juxtaposed with the temporal trends of CALGB 9343 clinical trial data, guideline recommendations, and publishing of long-term survival data.
RESULTS
The study cohort included 25,723 Medicare beneficiaries, of whom 20,328 (79%) received RT and 5395 (21%) did not receive RT. In a multivariate model, the frequency of RT omission increased over time, with those diagnosed in year 2015 being 2.72 times more likely to omit RT compared with those diagnosed in 2004 (95% confidence interval 2.31-3.19).
CONCLUSIONS
This study investigated the impact of long-term CALGB 9343 data on clinical practice. The results of this study support results from previous studies, extend the dates of analysis, and indicate that after long-term follow-up of CALGB 9343 data, RT was less used, but overall trends did not dramatically decrease.
Identifiants
pubmed: 32805580
pii: S0022-4804(20)30480-7
doi: 10.1016/j.jss.2020.07.023
pmc: PMC7882003
mid: NIHMS1630545
pii:
doi:
Substances chimiques
Receptors, Estrogen
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
577-583Subventions
Organisme : NCI NIH HHS
ID : T32 CA163177
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
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