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. 2021 Dec 24;7(2):100877.
doi: 10.1016/j.adro.2021.100877. eCollection 2022 Mar-Apr.

Adoption of Ultrahypofractionated Radiation Therapy in Patients With Breast Cancer

Kelsey L Corrigan  1 , Xiudong Lei  1 , Neelofur Ahmad  1 , Isidora Arzu  1 , Elizabeth Bloom  1 , Stephen G Chun  1 , Chelain Goodman  1 , Karen E Hoffman  1 , Melissa Joyner  1 , Lauren Mayo  1 , Melissa Mitchell  1 , Kevin T Nead  1 , George H Perkins  1 , Valerie Reed  1 , Jay P Reddy  1 , Pamela Schlembach  1 , Simona F Shaitelman  1 , Michael C Stauder  1 , Eric A Strom  1 , Welela Tereffe  1 , Lee Wiederhold  1 , Wendy A Woodward  1 , Benjamin D Smith  1
Affiliations

Adoption of Ultrahypofractionated Radiation Therapy in Patients With Breast Cancer

Kelsey L Corrigan et al. Adv Radiat Oncol. .

Abstract

Introduction: The first high-quality clinical trial to support ultrahypofractionated whole-breast irradiation (ultra-HF-WBI) for invasive early-stage breast cancer (ESBC) was published in April 2020, coinciding with the beginning of the COVID-19 pandemic. We analyzed adoption of ultra-HF-WBI for ductal carcinoma in situ (DCIS) and ESBC at our institution after primary trial publication.

Methods and materials: We evaluated radiation fractionation prescriptions for all patients with DCIS or ESBC treated with WBI from March 2020 to May 2021 at our main campus and regional campuses. Demographic and clinical characteristics were extracted from the electronic medical record. Treating physician characteristics were collected from licensure data. Hierarchical logistic regression models identified factors correlated with adoption of ultra-HF-WBI (26 Gy in 5 daily factions [UK-FAST-FORWARD] or 28.5 Gy in 5 weekly fractions [UK-FAST]).

Results: Of 665 included patients, the median age was 61.5 years, and 478 patients (71.9%) had invasive, hormone-receptor-positive breast cancer. Twenty-one physicians treated the included patients. In total, 249 patients (37.4%) received ultra-HF-WBI, increasing from 4.3% (2 of 46) in March-April 2020 to a high of 45.5% (45 of 99) in July-August 2020 (P < .001). Patient factors associated with increased use of ultra-HF-WBI included older age (≥50 years old), low-grade WBI without inclusion of the low axilla, no radiation boost, and farther travel distance (P < .03). Physician variation accounted for 21.7% of variance in the outcome, with rate of use of ultra-HF-WBI by the treating physicians ranging from 0% to 75.6%. No measured physician characteristics were associated with use of ultra-HF-WBI.

Conclusions: Adoption of ultra-HF-WBI at our institution increased substantially after the publication of randomized evidence supporting its use. Ultra-HF-WBI was preferentially used in patients with lower risk disease, suggesting careful selection for this new approach while long-term data are maturing. Substantial physician-level variation may reflect a lack of consensus on the evidentiary standards required to change practice.

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Figures

Fig 1
Fig. 1
Percentage of patients requiring whole-breast radiation therapy from March 2020 to May 2021 stratified by the type of fractionation prescribed.
Fig 2
Fig. 2
Proportion of patients receiving the UK-FAST or UK-FAST FORWARD fractionation regimen stratified by each treating physician. Sixteen attending physicians who treated at least 10 patients with breast cancer were included in this analysis. The 95% confidence interval bars take into account variability of the calculated rate based on the number of patients treated by each physician. Abbreviation: ultra-HF-WBI = ultrahypofractionated whole-breast irradiation.
See this image and copyright information in PMC

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