Changing practice patterns for breast cancer radiation therapy with clinical pathways: An analysis of hypofractionation in a large, integrated cancer center network

Practical Radiation Oncology
Malolan S RajagopalanSushil Beriwal

Abstract

Hypofractionated whole breast irradiation (HF-WBI) following breast conserving surgery has produced excellent outcomes, but utilization remains limited. We evaluated the impact of a clinical pathway in the adoption of HF-WBI in a large, integrated radiation oncology network. We identified patients aged ≥70 years treated for breast cancer or ductal carcinoma in situ. Patients treated with palliative intent, accelerated partial breast radiation, following mastectomy, or with axillary nodal, supraclavicular, or internal mammary fields were excluded. HF-WBI was defined as ≤20 fractions with a dose/fraction ≥2.5 Gy. Multivariate analysis identified variables associated with increased HF-WBI utilization. We identified 2426 patients meeting inclusion criteria. HF-WBI utilization increased significantly from 6.5% (22.0% academic, 2.0% community) before pathway modification to 33.8% afterwards (68.5% academic, 25.3% community, P<.001). For academic physicians, the relative risk of HF-WBI utilization was 3.8 following publication of the seminal HF-WBI trial and 10.6 following pathway modification (P < .001). For community physicians, the relative risk of HF-WBI utilization did not significantly change following publication but was 21.0 f...Continue Reading

References

Jun 8, 2006·JAMA : the Journal of the American Medical Association·Mark LoebThomas Marrie
Jul 20, 2010·International Journal of Radiation Oncology, Biology, Physics·Benjamin D SmithBruce G Haffty
May 22, 2013·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Kevin S HughesWilliam C Wood

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Citations

Nov 5, 2015·International Journal of Radiation Oncology, Biology, Physics·Bhavana V ChapmanSushil Beriwal
Feb 18, 2016·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Eric OjerholmJustin E Bekelman
Dec 12, 2018·Journal of Oncology Practice·Joshua L Rodríguez-LopézSushil Beriwal
Oct 24, 2017·Journal of the National Cancer Institute·Eric OjerholmJustin E Bekelman

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