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Trends and variations in postmastectomy radiation therapy for breast cancer in patients with 1 to 3 positive lymph nodes: A National Cancer Data Base analysis.

Publication ,  Journal Article
Ohri, N; Sittig, MP; Tsai, CJ; Hwang, E-SS; Mittendorf, EA; Shi, W; Zhang, Z; Ho, AY
Published in: Cancer
February 1, 2018

BACKGROUND: High-level evidence is lacking to guide treatment decisions about postmastectomy radiation therapy (PMRT) in patients who have breast cancer with 1 to 3 positive lymph nodes who receive contemporary systemic therapies, leading to potential variations in PMRT delivery. The objective of this study was to examine nationwide trends in PMRT use in this group. METHODS: The National Cancer Data Base (NCDB) was used to identify 93,372 women who had T1-T2N1 breast cancer diagnosed between 2003 and 2012. Patients who received neoadjuvant chemotherapy or radiation therapy (RT) and those who had bilateral breast cancers were excluded. Time trends were evaluated using the Cochrane-Armitage test and correlated the receipt of PMRT with various patient demographic, facility, clinicopathologic, and treatment variables using multivariable logistic regression. A second analysis was performed for patients who were diagnosed during 2010 and included radiation oncologist density as an additional covariate. P values < .0001 were considered statistically significant. RESULTS: Overall, 22.5% of the study population received PMRT, representing an increase from 19.1% in 2003 to 30.3% in 2012. Factors associated with greater PMRT use included younger age, lower Charlson-Deyo comorbidity scores, shorter distance to the treating facility, treatment at a comprehensive cancer program, facility location in the New England Census division, and higher density of radiation oncologists. Increased PMRT use was associated with later year of diagnosis, receipt of chemotherapy, receipt of hormone therapy, higher grade disease, larger tumor size, greater numbers of positive lymph nodes, positive margins, and absence of immediate breast reconstruction (all P < .0001). CONCLUSIONS: The receipt of PMRT by patients with breast cancer who have 1 to 3 positive lymph nodes has increased over time, with wide variability in practice patterns in the United States. Cancer 2018;124:482-90. © 2017 American Cancer Society.

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Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

February 1, 2018

Volume

124

Issue

3

Start / End Page

482 / 490

Location

United States

Related Subject Headings

  • Young Adult
  • Oncology & Carcinogenesis
  • Middle Aged
  • Mastectomy
  • Lymphatic Metastasis
  • Humans
  • Female
  • Databases, Factual
  • Combined Modality Therapy
  • Breast Neoplasms
 

Citation

APA
Chicago
ICMJE
MLA
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Ohri, N., Sittig, M. P., Tsai, C. J., Hwang, E.-S., Mittendorf, E. A., Shi, W., … Ho, A. Y. (2018). Trends and variations in postmastectomy radiation therapy for breast cancer in patients with 1 to 3 positive lymph nodes: A National Cancer Data Base analysis. Cancer, 124(3), 482–490. https://doi.org/10.1002/cncr.31080
Ohri, Nisha, Mark P. Sittig, Chiaojung Jillian Tsai, Eun-Sil Shelley Hwang, Elizabeth Ann Mittendorf, Weiji Shi, Zhigang Zhang, and Alice Y. Ho. “Trends and variations in postmastectomy radiation therapy for breast cancer in patients with 1 to 3 positive lymph nodes: A National Cancer Data Base analysis.Cancer 124, no. 3 (February 1, 2018): 482–90. https://doi.org/10.1002/cncr.31080.
Ohri, Nisha, et al. “Trends and variations in postmastectomy radiation therapy for breast cancer in patients with 1 to 3 positive lymph nodes: A National Cancer Data Base analysis.Cancer, vol. 124, no. 3, Feb. 2018, pp. 482–90. Pubmed, doi:10.1002/cncr.31080.
Ohri N, Sittig MP, Tsai CJ, Hwang E-SS, Mittendorf EA, Shi W, Zhang Z, Ho AY. Trends and variations in postmastectomy radiation therapy for breast cancer in patients with 1 to 3 positive lymph nodes: A National Cancer Data Base analysis. Cancer. 2018 Feb 1;124(3):482–490.
Journal cover image

Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

February 1, 2018

Volume

124

Issue

3

Start / End Page

482 / 490

Location

United States

Related Subject Headings

  • Young Adult
  • Oncology & Carcinogenesis
  • Middle Aged
  • Mastectomy
  • Lymphatic Metastasis
  • Humans
  • Female
  • Databases, Factual
  • Combined Modality Therapy
  • Breast Neoplasms