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The Use of Radiation As a Component of Breast Conservation Therapy in National Comprehensive Cancer Network Centers

From the Department of Radiation Oncology and Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Oncology, City of Hope Hospital, Los Angeles, CA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Department of Breast and Soft Tissue Surgery, Roswell Park Cancer Institute, Buffalo, NY; and Department of Oncology, Fox Chase Cancer Center, Philadelphia, PA

Address reprint requests to Thomas A. Buchholz, MD, Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcolmbe Blvd, Unit 1202, Houston, TX 77030; e-mail: tbuchhol{at}mdanderson.org

Purpose Benchmark data regarding quality measures of breast cancer management are needed. We investigated rates of radiation use after breast conservation therapy (BCT) for patients treated for ductal carcinoma-in-situ (DCIS) or invasive breast cancer at National Comprehensive Cancer Network (NCCN) centers.

Patients and Methods We studied 3,333 consecutive patients treated between 1997 and 2002 with BCT for DCIS (n = 587) or for stage I or II breast cancer (n = 2,746) in eight NCCN centers.

Results The overall rate of radiation therapy use was 91%, with a lower frequency of radiation use in DCIS versus invasive breast cancers (82% v 94%; odds ratio [OR] = 0.31; P < .0001). In a multivariable analysis of the patients with DCIS, the only factor significantly associated with lower rates of radiation use was low/intermediate grade (OR = 0.19; P = .0003). For patients with invasive breast cancer, significant factors were presence of comorbidity (OR = 0.53; P = .0005), tubular histology (OR = 0.39; P = .02), type of health insurance (P = .0072), and the NCCN institution (P = .0005). The model also showed lower rates of radiation use in patients with stage II disease who did not receive systemic therapy (OR = 0.01; P = .0001), younger patients who did not receive systemic therapy (P = .003); and older patients with stage I disease (P < .0001).

Conclusion Radiation use as a component of BCT was high for patients seen at NCCN centers; however, there was variability in practice patterns noted across institutions. Radiation was most commonly omitted in patients with favorable disease characteristics, patients with comorbidities, and patients who also did not receive guideline-recommended systemic treatment.

Supported in part by the Nellie B. Conally Breast Cancer Research Fund, The University of Texas M.D. Anderson Cancer Center, and by Grant No. P50CA89393 to the Dana-Farber Cancer Institute from the National Cancer Institute.

Presented at the 2004 American Radium Society Meeting, May 1-5, 2004, Houston, TX, and the 2004 NCCN Meeting, March 12, 2004, Hollywood, FL.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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