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.

中文翻译：

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在 COVID-19 大流行开始时用于早期乳腺癌的放射治疗中分割使用的变化：英格兰和威尔士老年妇女基于人群的队列研究

目标

对于大多数接受保乳手术的早期乳腺癌（EBC）患者和接受乳房切除术治疗的中/高复发风险患者，建议进行辅助放疗。在英格兰和威尔士的第一波 COVID-19 疫情期间，基于随机对照试验的证据迅速传播，表明与标准中度 HFRT 相比，五分割超大分割放射治疗 (HFRT) 方案具有非劣效性，指导建议对符合条件的患者使用五分次 HFRT。作为全国老年患者乳腺癌审计 (NABCOP) 的一部分，我们评估了该建议在临床实践中的采纳情况。

材料和方法

从英格兰快速癌症登记数据集和威尔士癌症网络数据中确定了 2019 年 1 月至 2020 年 7 月接受 EBC 手术的 50 岁以上的女性。放射治疗细节来自相关的国家放射治疗数据集。多变量混合效应逻辑回归模型用于评估影响超高频放疗使用的特征。

结果

在接受 EBC 手术的 35 561 名女性中，71% 接受了术后放疗。接受 26 Gy 的五次分割 (26Gy5F) 从 2020 年 2 月的 <1% 增加到 2020 年 4 月的 70%。2020 年 4 月至 2020 年 7 月期间使用 26Gy5F 的区域差异与年龄相似，女性的范围从 49% 到 87%年龄≥70岁。使用 26Gy5F 的特点是没有已知的淋巴结受累、没有合并症和最初的保乳手术。在接受乳房/胸壁放疗的患者中，85% 有 26Gy5F；如果放疗包括区域淋巴结，则 23% 有 26Gy5F。在 2020 年 4 月至 2020 年 7 月接受术后放疗的 5139 名女性中，淋巴结受累、总体分期、手术类型、从诊断到开始放疗的时间与分割选择独立相关。

结论

在英格兰和威尔士 COVID-19 大流行开始时发布指南的一个月内，50 岁以上的女性对 EBC 的 26Gy5F 剂量分割方案的使用显着增加。