Study Finds Use of Accelerated Partial-Breast Irradiation Has Stagnated
Accelerated partial-breast irradiation was designed to be a faster, more convenient, and potentially safer way for many women with breast cancer to reduce their mortality risk and help keep their cancer from returning after surgery. But a new study shows that despite the availability of accelerated partial-breast irradiation, the percentage of early-stage breast cancer patients who could benefit from the radiation treatment is not increasing. The findings were published by Yao and Recht in the American Journal of Surgery.
Accelerated Partial-Breast Irradiation
Accelerated partial-breast irradiation was created as an alternative to traditional radiation therapy for women with breast cancer who have had a lumpectomy or breast-conserving surgery. Both forms of radiation therapy aim to prevent the spread of any cancer cells that may remain after tumor removal.
Traditional radiation treatment requires weeks of daily treatment, and the radiation can damage the lungs and heart; accelerated partial-breast irradiation, on the other hand, condenses the treatments into only 5 days and can avoid some of the toxicities and tissue damage associated with the traditional approach. As such, it was hoped the availability of the accelerated approach would reduce the percentage of women who did not receive radiotherapy.
“The problem is that [traditional] radiation therapy is a long-course treatment. Normally you see your radiation oncologist every day for 5 to 7 weeks. Each treatment is only a few minutes, but it’s not convenient at all for a lot of patients,” explained Nengliang (Aaron) Yao, PhD, of the University of Virginia School of Medicine's Department of Public Health Sciences. “This new therapy is actually improving convenience and reducing toxicity, and has become more accessible over time, but you don't see an improvement in adherence to radiation therapy after lumpectomy.”
Study Findings
Dr. Yao and Abram Recht, MD, of Harvard Medical School, looked at data from the 2014 Surveillance, Epidemiology, and End Results (SEER) database. The researchers identified 309,429 women who were diagnosed with breast cancer between January 2000 and June 2011. They found that approximately 14% of patients with early-stage breast cancer did not receive radiation treatments after breast-conserving surgery over the course of the study period.
Accelerated partial-breast irradiation was first developed in the late 1990s. Use increased rapidly from 0.2% in 2000 to about 3.1% in 2008. Medicare began reimbursing for the procedure in 2004, and in 2009, the American Association of Radiation Oncologists issued a consensus statement to provide guidance for patients and physicians regarding the use of accelerated partial-breast irradiation. But that guideline was not followed by an increase in its adoption, the researchers found. Instead, use has leveled off. The availability of the treatment, they determined, has not statistically reduced the percentage of women who undergo lumpectomy and do not receive radiotherapy.
“My conclusion is that noncompliance with adjuvant radiation is still common when the shortened radiation therapy becomes increasingly accessible,” Dr. Yao said. “We have 12 years of data. That's enough to tell the story.”
The study did not look at the causes for the stagnation in the use of the accelerated treatment, but Drs. Yao and Recht hope to continue to investigate the matter in future research.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
