Temporal Trends in Postmastectomy Radiation Therapy and Breast Reconstruction Associated With Changes in National Comprehensive Cancer Network Guidelines.

摘要: Importance Evolving data on the effectiveness of postmastectomy radiation therapy (PMRT) have led to changes in National Comprehensive Cancer Network (NCCN) recommendations, counseling clinicians “strongly consider” PMRT for patients with breast cancer tumors 5 cm or smaller and 1 3 positive nodes; however, anticipation may lead delay omission reconstruction, which can cosmetic, quality-of-life, complication implications patients. Objective To determine whether revised guidelines increased affected receipt reconstruction. We hypothesized that (1) rates would increase women by while remaining stable other cohorts (2) reconstruction decrease these increasing groups. Design, Setting, Participants Retrospective, population-based cohort study Surveillance, Epidemiology, End Results (SEER) stage I III undergoing mastectomy from 2000 through 2011. Our analytic sample (N = 62 442) was divided into basis current NCCN radiotherapy recommendations: “radiotherapy recommended” (tumors >5 ≥4 lymph nodes), consider radiotherapy” (tumor ≤5 cm, 1-3 not no nodes). Main Outcomes Measures used Joinpoint regression analysis evaluate temporal trends The comprised 15 999 group, 15 006 31 837 group. Rates were unchanged recommended (29.9%) (7.4%) over period. Receipt strongly at 26.9% until 2007. At time, a significant change APC observed ( P  = .01) an 2.1% 9.0% P  = .02) end period, final rate 40.5%. Breast across all cohorts. Despite PMRT, maintained consistent (annual percentage change, 7.4%) throughout This is similar (10.7%) (8.4%) Conclusions Relevance Changes been associated among nodes without represent clinician comfort irradiating new cosmetic quality-of-life