Adoption of Ultrahypofractionated Radiation Therapy in Patients With Breast Cancer

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

Advances in Radiation Oncology (Mar 2022)

Adoption of Ultrahypofractionated Radiation Therapy in Patients With Breast Cancer

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

Affiliations

Kelsey L. Corrigan, MD, MPH: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Xiudong Lei, PhD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Neelofur Ahmad, MD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Isidora Arzu, MD, PhD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Elizabeth Bloom, MD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Stephen G. Chun, MD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Chelain Goodman, MD, PhD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Karen E. Hoffman, MD, MHSc, MPH: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Melissa Joyner, MD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Lauren Mayo, MD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Melissa Mitchell, MD, PhD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Kevin T. Nead, MD, MPhil: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
George H. Perkins, MD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Valerie Reed, MD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Jay P. Reddy, MD, PhD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Pamela Schlembach, MD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Simona F. Shaitelman, MD, EdM: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Michael C. Stauder, MD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Eric A. Strom, MD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Welela Tereffe, MD, MPH: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Lee Wiederhold, MD, PhD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Wendy A. Woodward, MD, PhD: Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
Benjamin D. Smith, MD: Corresponding author: Benjamin D. Smith, M.D.; Department of Breast Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA

Journal volume & issue: Vol. 7, no. 2
p. 100877

Abstract

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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.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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