Choosing wisely after publication of level I evidence in breast cancer radiotherapy

Figures & data

Figure 1 Rates of hypofractionation and RT omission for the years 2006–2008 and 2011–2013. WBRT hypofractionation rates are for patients aged ≥50 years with hormone receptor-positive, early-stage breast cancer. RT omission rates are for patients aged >70 years. Rates at our NCCN-member institution are compared to national rates per Bekelman et al²⁴ and Palta et al.²⁵P<0.001 for statistical difference between the 2006–2008 and 2011–2013 institution-specific hypofractionation rates. P=0.11 for statistical difference between the 2006–2008 and 2011–2013 institution-specific RT omission rates.

Abbreviations: NCCN, National Comprehensive Center Network; RT, radiotherapy; WBRT, whole-breast radiotherapy.

Table 1 RT practice patterns for patients aged ≥50 years with hormone receptor-positive, early-stage breast cancer at our NCCN-member institution

Characteristic	Years		P-value
	2006–2008	2011–2013
Patients (N)	55	83
Age (SD), mean, years	72.1 (9.0)	70.7 (8.9)	0.37
Stage
T1a	5	8	0.95
T1b	21	29	–
T1c	24	36	–
T2	5	10	–
RT practice patterns, N (%)
Traditional WBRT	38 (69.1)	16 (19.3)	<0.001
Hypofractionated WBRT	6 (10.9)	45 (54.2)	–
RT omission	11 (20.0)	22 (26.5)	–
Age >70 years, N	34	42	0.22
RT omission, N (%)	10 (29.4)	20 (47.6)	0.11

Abbreviations: NCCN, National Comprehensive Center Network; RT, radiotherapy; WBRT, whole-breast radiotherapy.

Table 2 Direct medical cost for whole-breast radiotherapy

Code	Description	Technical cost ($)	Professional cost ($)	Total cost ($)	3DCRT	IMRT	3DCRT	IMRT
					15 fractions	15 fractions	25 fractions	25 fractions
77263	Clinical treatment planning, complex	–	167.56	167.56	1	1	1	1
77280	Simulation, simple	166.65	36.52	203.17	1	–	1	–
77290	Simulation, complex	291.77	81.99	373.76	1	–	1	–
77293	Respiratory motion management	–	104.91	104.91	0.5	–	0.5	–
77295	3DCRT treatment plan	1,026.81	224.13	1,250.94	1	–	1	–
77300	Dosimetry calculation	107.40	32.58	139.98	2	2	2	2
77301	IMRT treatment plan	1,026.81	417.84	1,444.65	–	1	–	1
77321	Electron boost plan	291.77	49.77	341.54	–	–	–	–
77334	Treatment devices	291.77	64.81	356.58	3	1	3	1
77336	Weekly physics	107.40	–	107.40	3	3	5	5
77338	Design MLC for IMRT	291.77	224.13	515.90	–	1	–	1
77385	IMRT treatment delivery, simple	505.51	–	505.51	–	15	–	25
77412	3DCRT/electron treatment delivery	194.35	–	194.35	15	–	25	–
77417	Weekly port films	NC	–	–	3	–	5	–
77427	Weekly RT management	–	187.61	187.61	3	3	5	5
Direct medical cost ($)					7,197.87	11,232.33	9,731.39	16,877.45

Abbreviations: –, not applicable; 3DCRT, 3-dimensional conformal radiotherapy; IMRT, intensity-modulated radiotherapy; MLC, multileaf collimator; NC, no charge; RT, radiotherapy.

BekelmanJESylwestrzakGBarronJUptake and costs of hypofractionated vs conventional whole breast irradiation after breast conserving surgery in the United States, 2008–2013JAMA2014312232542255025494006

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