Variation in the use of boost irradiation in breast conserving therapy in the Netherlands

Kay Schreuder, P. Spronk, J.H. Maduro, P.M. Poortmans, N. Bijker, H. Struikmans, S. Siesling

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Abstract

Background: A boost dose is applied after breast conserving surgery (BCS) and whole breast irradiation to further reduce the risk of local recurrences in breast cancer. In the NABON Breast Cancer Audit (NBCA) variation in the use of the boost was seen. Identification of factors explaining this variation can be useful to reduce possible undesirable variance in clinical practice. Aims of the current study were to determine the variation of the use of boost irradiation over time and between radiation oncology departments. We also investigated which patient and tumour factors were associated with the use of a boost. Material and Methods: From the NBCA cohort, all patients with primary DCIS or invasive breast cancer without distant metastatic disease diagnosed between January 1, 2011 and December 31, 2014 were selected. Funnel plots were used to evaluate the variation in the use of a boost between departments and over time. Logistic regression was performed to determine factors influencing the variation. Analyses were performed in STATA (version 13.1 2013, Texas). Results: During the study period, 33,902 female patients were treated with radiation for DCIS or invasive breast cancer after BCS. In total 51% of the patients received a boost (45% DCIS, 54% invasive, Table 1). Variation between the 23 departments of radiation oncology was seen for both DCIS and invasive tumours. For DCIS patients, the use of the boost slightly increases over time while for invasive tumours a decrease was seen. Multivariable logistic regression (Table 2) demonstrates that lower age (<50 years), larger tumours (>2 cm diameter), grade 3 and irradical surgery increased boost application for both DCIS and invasive breast cancers. Positive lymph nodes significantly influences boost prescription for invasive breast cancers. Variation could not completely be explained by patient and tumour characteristics. Table 1. DCIS (n = 4,568) Invasive (n = 29,334) % Boost 45% 54% Variation between institutions (n = 23) 5−92% 21−80% % boost in 2011 (range) 45% (5–100%) 61% (14–100%) % boost in 2014 (range) 46% (5−86%) 44% (25−59%) Table 2. Multivariable logistic regression boost vs no boost DCIS (n = 4,568) Invasive (n = 29,334) OR 95%CI OR 95%CI Age <50 vs >50 years 1.8 1.6−2.0 8.0 7.4−8.7 Larger (>2 cm) vs smaller (<2 cm) tumours 1.6 1.2−2.1 1.1 1.0−1.2 Grade 3 vs grade 1 2.5 2.1−3.1 7.0 6.4−7.6 Irradicality 14.0 9.3–21.2 9.5 8.0–11.3 Positive lymph nodes 1.4 1.3−1.5 Conclusion: In the Netherlands, a large variation between departments was found for the use of a boost for breast conserving treatment in both invasive breast cancer and DCIS, which could not be explained completely by patient and tumour characteristics. Other factors such as involvement in clinical decision making of the patient for balancing the recurrence risk versus the expected cosmetic result could explain variation and have to be studied in future.
Original languageEnglish
PagesS56
Number of pages1
Publication statusPublished - 11 Mar 2016
Event10th European Breast Cancer Conference (EBCC-10) : Multidisciplinary Innovation in Breast Cancer Care - RAI Amsterdam, Amsterdam, Netherlands
Duration: 9 Mar 201611 Mar 2016
Conference number: 10

Conference

Conference10th European Breast Cancer Conference (EBCC-10)
Abbreviated titleEBCC
CountryNetherlands
CityAmsterdam
Period9/03/1611/03/16

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Carcinoma, Intraductal, Noninfiltrating
Netherlands
Breast
Breast Neoplasms
Neoplasms
Segmental Mastectomy
Logistic Models
Therapeutics
Lymph Nodes
Radiation
Radiation Oncology
Cosmetics
Recurrence

Keywords

  • METIS-316254
  • IR-100066

Cite this

Schreuder, K., Spronk, P., Maduro, J. H., Poortmans, P. M., Bijker, N., Struikmans, H., & Siesling, S. (2016). Variation in the use of boost irradiation in breast conserving therapy in the Netherlands. S56. Poster session presented at 10th European Breast Cancer Conference (EBCC-10) , Amsterdam, Netherlands.
Schreuder, Kay ; Spronk, P. ; Maduro, J.H. ; Poortmans, P.M. ; Bijker, N. ; Struikmans, H. ; Siesling, S. / Variation in the use of boost irradiation in breast conserving therapy in the Netherlands. Poster session presented at 10th European Breast Cancer Conference (EBCC-10) , Amsterdam, Netherlands.1 p.
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title = "Variation in the use of boost irradiation in breast conserving therapy in the Netherlands",
abstract = "Background: A boost dose is applied after breast conserving surgery (BCS) and whole breast irradiation to further reduce the risk of local recurrences in breast cancer. In the NABON Breast Cancer Audit (NBCA) variation in the use of the boost was seen. Identification of factors explaining this variation can be useful to reduce possible undesirable variance in clinical practice. Aims of the current study were to determine the variation of the use of boost irradiation over time and between radiation oncology departments. We also investigated which patient and tumour factors were associated with the use of a boost. Material and Methods: From the NBCA cohort, all patients with primary DCIS or invasive breast cancer without distant metastatic disease diagnosed between January 1, 2011 and December 31, 2014 were selected. Funnel plots were used to evaluate the variation in the use of a boost between departments and over time. Logistic regression was performed to determine factors influencing the variation. Analyses were performed in STATA (version 13.1 2013, Texas). Results: During the study period, 33,902 female patients were treated with radiation for DCIS or invasive breast cancer after BCS. In total 51{\%} of the patients received a boost (45{\%} DCIS, 54{\%} invasive, Table 1). Variation between the 23 departments of radiation oncology was seen for both DCIS and invasive tumours. For DCIS patients, the use of the boost slightly increases over time while for invasive tumours a decrease was seen. Multivariable logistic regression (Table 2) demonstrates that lower age (<50 years), larger tumours (>2 cm diameter), grade 3 and irradical surgery increased boost application for both DCIS and invasive breast cancers. Positive lymph nodes significantly influences boost prescription for invasive breast cancers. Variation could not completely be explained by patient and tumour characteristics. Table 1. DCIS (n = 4,568) Invasive (n = 29,334) {\%} Boost 45{\%} 54{\%} Variation between institutions (n = 23) 5−92{\%} 21−80{\%} {\%} boost in 2011 (range) 45{\%} (5–100{\%}) 61{\%} (14–100{\%}) {\%} boost in 2014 (range) 46{\%} (5−86{\%}) 44{\%} (25−59{\%}) Table 2. Multivariable logistic regression boost vs no boost DCIS (n = 4,568) Invasive (n = 29,334) OR 95{\%}CI OR 95{\%}CI Age <50 vs >50 years 1.8 1.6−2.0 8.0 7.4−8.7 Larger (>2 cm) vs smaller (<2 cm) tumours 1.6 1.2−2.1 1.1 1.0−1.2 Grade 3 vs grade 1 2.5 2.1−3.1 7.0 6.4−7.6 Irradicality 14.0 9.3–21.2 9.5 8.0–11.3 Positive lymph nodes 1.4 1.3−1.5 Conclusion: In the Netherlands, a large variation between departments was found for the use of a boost for breast conserving treatment in both invasive breast cancer and DCIS, which could not be explained completely by patient and tumour characteristics. Other factors such as involvement in clinical decision making of the patient for balancing the recurrence risk versus the expected cosmetic result could explain variation and have to be studied in future.",
keywords = "METIS-316254, IR-100066",
author = "Kay Schreuder and P. Spronk and J.H. Maduro and P.M. Poortmans and N. Bijker and H. Struikmans and S. Siesling",
year = "2016",
month = "3",
day = "11",
language = "English",
pages = "S56",
note = "10th European Breast Cancer Conference (EBCC-10) : Multidisciplinary Innovation in Breast Cancer Care, EBCC ; Conference date: 09-03-2016 Through 11-03-2016",

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Schreuder, K, Spronk, P, Maduro, JH, Poortmans, PM, Bijker, N, Struikmans, H & Siesling, S 2016, 'Variation in the use of boost irradiation in breast conserving therapy in the Netherlands' 10th European Breast Cancer Conference (EBCC-10) , Amsterdam, Netherlands, 9/03/16 - 11/03/16, pp. S56.

Variation in the use of boost irradiation in breast conserving therapy in the Netherlands. / Schreuder, Kay ; Spronk, P.; Maduro, J.H.; Poortmans, P.M.; Bijker, N.; Struikmans, H.; Siesling, S.

2016. S56 Poster session presented at 10th European Breast Cancer Conference (EBCC-10) , Amsterdam, Netherlands.

Research output: Contribution to conferencePoster

TY - CONF

T1 - Variation in the use of boost irradiation in breast conserving therapy in the Netherlands

AU - Schreuder, Kay

AU - Spronk, P.

AU - Maduro, J.H.

AU - Poortmans, P.M.

AU - Bijker, N.

AU - Struikmans, H.

AU - Siesling, S.

PY - 2016/3/11

Y1 - 2016/3/11

N2 - Background: A boost dose is applied after breast conserving surgery (BCS) and whole breast irradiation to further reduce the risk of local recurrences in breast cancer. In the NABON Breast Cancer Audit (NBCA) variation in the use of the boost was seen. Identification of factors explaining this variation can be useful to reduce possible undesirable variance in clinical practice. Aims of the current study were to determine the variation of the use of boost irradiation over time and between radiation oncology departments. We also investigated which patient and tumour factors were associated with the use of a boost. Material and Methods: From the NBCA cohort, all patients with primary DCIS or invasive breast cancer without distant metastatic disease diagnosed between January 1, 2011 and December 31, 2014 were selected. Funnel plots were used to evaluate the variation in the use of a boost between departments and over time. Logistic regression was performed to determine factors influencing the variation. Analyses were performed in STATA (version 13.1 2013, Texas). Results: During the study period, 33,902 female patients were treated with radiation for DCIS or invasive breast cancer after BCS. In total 51% of the patients received a boost (45% DCIS, 54% invasive, Table 1). Variation between the 23 departments of radiation oncology was seen for both DCIS and invasive tumours. For DCIS patients, the use of the boost slightly increases over time while for invasive tumours a decrease was seen. Multivariable logistic regression (Table 2) demonstrates that lower age (<50 years), larger tumours (>2 cm diameter), grade 3 and irradical surgery increased boost application for both DCIS and invasive breast cancers. Positive lymph nodes significantly influences boost prescription for invasive breast cancers. Variation could not completely be explained by patient and tumour characteristics. Table 1. DCIS (n = 4,568) Invasive (n = 29,334) % Boost 45% 54% Variation between institutions (n = 23) 5−92% 21−80% % boost in 2011 (range) 45% (5–100%) 61% (14–100%) % boost in 2014 (range) 46% (5−86%) 44% (25−59%) Table 2. Multivariable logistic regression boost vs no boost DCIS (n = 4,568) Invasive (n = 29,334) OR 95%CI OR 95%CI Age <50 vs >50 years 1.8 1.6−2.0 8.0 7.4−8.7 Larger (>2 cm) vs smaller (<2 cm) tumours 1.6 1.2−2.1 1.1 1.0−1.2 Grade 3 vs grade 1 2.5 2.1−3.1 7.0 6.4−7.6 Irradicality 14.0 9.3–21.2 9.5 8.0–11.3 Positive lymph nodes 1.4 1.3−1.5 Conclusion: In the Netherlands, a large variation between departments was found for the use of a boost for breast conserving treatment in both invasive breast cancer and DCIS, which could not be explained completely by patient and tumour characteristics. Other factors such as involvement in clinical decision making of the patient for balancing the recurrence risk versus the expected cosmetic result could explain variation and have to be studied in future.

AB - Background: A boost dose is applied after breast conserving surgery (BCS) and whole breast irradiation to further reduce the risk of local recurrences in breast cancer. In the NABON Breast Cancer Audit (NBCA) variation in the use of the boost was seen. Identification of factors explaining this variation can be useful to reduce possible undesirable variance in clinical practice. Aims of the current study were to determine the variation of the use of boost irradiation over time and between radiation oncology departments. We also investigated which patient and tumour factors were associated with the use of a boost. Material and Methods: From the NBCA cohort, all patients with primary DCIS or invasive breast cancer without distant metastatic disease diagnosed between January 1, 2011 and December 31, 2014 were selected. Funnel plots were used to evaluate the variation in the use of a boost between departments and over time. Logistic regression was performed to determine factors influencing the variation. Analyses were performed in STATA (version 13.1 2013, Texas). Results: During the study period, 33,902 female patients were treated with radiation for DCIS or invasive breast cancer after BCS. In total 51% of the patients received a boost (45% DCIS, 54% invasive, Table 1). Variation between the 23 departments of radiation oncology was seen for both DCIS and invasive tumours. For DCIS patients, the use of the boost slightly increases over time while for invasive tumours a decrease was seen. Multivariable logistic regression (Table 2) demonstrates that lower age (<50 years), larger tumours (>2 cm diameter), grade 3 and irradical surgery increased boost application for both DCIS and invasive breast cancers. Positive lymph nodes significantly influences boost prescription for invasive breast cancers. Variation could not completely be explained by patient and tumour characteristics. Table 1. DCIS (n = 4,568) Invasive (n = 29,334) % Boost 45% 54% Variation between institutions (n = 23) 5−92% 21−80% % boost in 2011 (range) 45% (5–100%) 61% (14–100%) % boost in 2014 (range) 46% (5−86%) 44% (25−59%) Table 2. Multivariable logistic regression boost vs no boost DCIS (n = 4,568) Invasive (n = 29,334) OR 95%CI OR 95%CI Age <50 vs >50 years 1.8 1.6−2.0 8.0 7.4−8.7 Larger (>2 cm) vs smaller (<2 cm) tumours 1.6 1.2−2.1 1.1 1.0−1.2 Grade 3 vs grade 1 2.5 2.1−3.1 7.0 6.4−7.6 Irradicality 14.0 9.3–21.2 9.5 8.0–11.3 Positive lymph nodes 1.4 1.3−1.5 Conclusion: In the Netherlands, a large variation between departments was found for the use of a boost for breast conserving treatment in both invasive breast cancer and DCIS, which could not be explained completely by patient and tumour characteristics. Other factors such as involvement in clinical decision making of the patient for balancing the recurrence risk versus the expected cosmetic result could explain variation and have to be studied in future.

KW - METIS-316254

KW - IR-100066

M3 - Poster

SP - S56

ER -

Schreuder K, Spronk P, Maduro JH, Poortmans PM, Bijker N, Struikmans H et al. Variation in the use of boost irradiation in breast conserving therapy in the Netherlands. 2016. Poster session presented at 10th European Breast Cancer Conference (EBCC-10) , Amsterdam, Netherlands.