Intensity-modulated radiation therapy in breast cancer patients following the release of a Choosing Wisely recommendation
Menée à partir des données de la base Medicare et des registres américains des cancers portant sur 13 457 patientes atteintes d'un cancer du sein diagnostiqué entre 2012 et 2015 et traité par chirurgie conservatrice en combinaison avec une radiothérapie adjuvante, cette étude analyse l'évolution de l'utilisation de la radiothérapie avec modulation d'intensité après la publication en 2013 par "the American Society for Radiation Oncology" d'une recommandation contre son utilisation systématique
In 2013, the American Society for Radiation Oncology recommended against the routine use of intensity-modulated radiation therapy (IMRT) in breast cancer patients. We evaluated trends in the use of IMRT before and after the release of the recommendation. Using SEER-Medicare data, we identified 13,457 breast cancer patients diagnosed between 2012 and 2015 who received breast conserving surgery and post-surgery, whole breast, IMRT or three dimensional conformal radiotherapy. We find that the use of IMRT decreased by 4.6 (95% CI: 3.6 to 5.6; two-sided p < 0.001) percentage points in hospital-based clinics. In freestanding radiotherapy clinics, which had baseline rates of IMRT use that were over 20 percentage points higher than in hospital-based clinics, use of IMRT declined by 6.1 (95% CI: 3.5 to 8.7; two-sided p < 0.001) percentage points. Use of IMRT declined following the release of the recommendation, but a large share of patients treated in freestanding clinics continue to receive IMRT.
Journal of the National Cancer Institute , résumé, 2018