Your browser doesn't support javascript.
Change in the Use of Fractionation in Radiotherapy Used for Early Breast Cancer at the Start of the COVID-19 Pandemic: A Population-Based Cohort Study of Older Women in England and Wales.
Gannon, M R; Dodwell, D; Miller, K; Horgan, K; Clements, K; Medina, J; Kunkler, I; Cromwell, D A.
  • Gannon MR; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK. Electronic address: melissa.gannon@lshtm.ac.uk.
  • Dodwell D; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • Miller K; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
  • Horgan K; Department of Breast Surgery, St James's University Hospital, Leeds, UK.
  • Clements K; National Cancer Registration and Analysis Service, NHS Digital, Birmingham, UK.
  • Medina J; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
  • Kunkler I; University of Edinburgh, Edinburgh, UK.
  • Cromwell DA; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
Clin Oncol (R Coll Radiol) ; 34(9): e400-e409, 2022 09.
Article in English | MEDLINE | ID: covidwho-1866988
ABSTRACT

AIMS:

Adjuvant radiotherapy is recommended for most patients with early breast cancer (EBC) receiving breast-conserving surgery and those at moderate/high risk of recurrence treated by mastectomy. During the first wave of COVID-19 in England and Wales, there was rapid dissemination of randomised controlled trial-based evidence showing non-inferiority for five-fraction ultra-hypofractionated radiotherapy (HFRT) regimens compared with standard moderate-HFRT, with guidance recommending the use of five-fraction HFRT for eligible patients. We evaluated the uptake of this recommendation in clinical practice as part of the National Audit of Breast Cancer in Older Patients (NABCOP). MATERIALS AND

METHODS:

Women aged ≥50 years who underwent surgery for EBC from January 2019 to July 2020 were identified from the Rapid Cancer Registration Dataset for England and from Wales Cancer Network data. Radiotherapy details were from linked national Radiotherapy Datasets. Multivariate mixed-effects logistic regression models were used to assess characteristics influential in the use of ultra-HFRT.

RESULTS:

Among 35 561 women having surgery for EBC, 71% received postoperative radiotherapy. Receipt of 26 Gy in five fractions (26Gy5F) increased from <1% in February 2020 to 70% in April 2020. Regional variation in the use of 26Gy5F during April to July 2020 was similar by age, ranging from 49 to 87% among women aged ≥70 years. Use of 26Gy5F was characterised by no known nodal involvement, no comorbidities and initial breast-conserving surgery. Of those patients receiving radiotherapy to the breast/chest wall, 85% had 26Gy5F; 23% had 26Gy5F if radiotherapy included regional nodes. Among 5139 women receiving postoperative radiotherapy from April to July 2020, nodal involvement, overall stage, type of surgery, time from diagnosis to start of radiotherapy were independently associated with fractionation choice.

CONCLUSIONS:

There was a striking increase in the use of 26Gy5F dose fractionation regimens for EBC, among women aged ≥50 years, within a month of guidance published at the start of the COVID-19 pandemic in England and Wales.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Breast Neoplasms / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans Country/Region as subject: Europa Language: English Journal: Clin Oncol (R Coll Radiol) Journal subject: Neoplasms Year: 2022 Document Type: Article

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Breast Neoplasms / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans Country/Region as subject: Europa Language: English Journal: Clin Oncol (R Coll Radiol) Journal subject: Neoplasms Year: 2022 Document Type: Article