Fractionation in adjuvant radiotherapy for invasive breast cancer and ductal carcinoma in situ in Ontario, Canada from 2009 to 2015

Abstract

The use of hypofractionated radiotherapy (HFRT) in patients with breast cancer and ductal carcinoma in situ (DCIS) in Ontario, Canada, from 2009 to 2015 was reported.A retrospective cohort study was conducted using data from the Institute for Clinical Evaluative Sciences (ICES). Patients with a breast cancer or DCIS diagnosis between 2009 and 2015 who received adjuvant breast or chest wall radiation were included.Trends in HFRT use (≤16 fractions) and factors associated with HFRT use in a multivariable logistic regression model with physician-level random effect were reported.The approximate number of hours that could be saved if all patients were to receive HFRT was calculated. A total of 42 072 patients were included. All included characteristics were significantly associated with HFRT use. Hypofractionated radiotherapy use in patients with breast cancer and DCIS increased to around 75% in 2015. In stage I/II patients with mastectomy and chest wall radiation, HFRT use increased to 40% in 2015. Hypofractionated radiotherapy use in patients with regional nodal radiation or reconstruction has increased but remains under 20%. For breast cancer patients with breast-conserving surgery (BCS) and breast radiation, 56 265 visits corresponding to 7200 hours of treatment or 3500 additional HFRT courses could have been saved. In conclusion, HFRT use in Ontario has increased in all patient populations but is nonuniform among physicians and institutions. Use of HFRT in chest wall and regional nodal radiation remains relatively lower than in breast cancer and DCIS patients with BCS. K E Y W O R D Sadjuvant radiotherapy, breast cancer, DCIS, hypofractionation, regional nodal radiation | 603 CHAN et Al.

Hypofractionated radiotherapy in the real-world setting: An international ESTRO-GIRO survey

“…This compares to 50% in our survey who reported using hypofractionated chest wall radiotherapy. 25 Similar trends of increasing breast hypofractionation have also been reported in other countries, including Australia and Spain. 26,27 The recently-published FAST-Forward trial reported the 5-year results of randomising older women with low-risk disease to either moderate hypofractionation (40Gy in 15 fractions) or ultra-hypofractionated radiotherapy (26-27Gy in 5 fractions over 1 week).…”

Evidence-based guidelines for hypofractionated radiation in breast cancer: conclusions of the Catalan expert working group

“…Indications for its use have also broadened with the growing body of evidence showing its utility under other circumstances, for example with irradiation of lymph nodes [6] or the chest wall following mastectomy [7], or in patients of all ages [8]. However, there are substantial variations in the use of hypofractionation across different centres and countries [9,10]. In a previous study, our group assessed its use for breast cancer in Catalonia, Spain [11], finding that it ranged from 8.9 to 74.7% of patients treated with a curative intent.…”

Cost Minimization Analysis of Hypofractionated Radiotherapy

“…Clearly, such regimens present considerable clinical and fiscal opportunity, but they must be assessed very cautiously before large-scale implementation. Because hypofractionated treatment regimens are becoming increasingly frequent treatment options in Canadian hospitals [12], it is important to have accurate information related to their associated costs or savings. For such reasons, we performed a detailed analysis of these novel regimens from a typical Canadian perspective, comparing a standard radiotherapy treatment regimen of 42.5 Gy in 16 fractions over 5 weeks to the hypofractionated regimens seen in the UK FAST and FAST-Forward trials.…”