Reshma Jagsi1, Kent A Griffith2, Frank A Vicini3, Eyad Abu-Isa4, Derek Bergsma5, Amit Bhatt6, Joshua T Dilworth7, Michael Dominello8, Stephen Franklin9, David K Heimburger10, Isaac Kaufman11, Paul G Kocheril12, Annette E Kretzler13, Peter Paximadis14, Jeffrey D Radawski15, Eleanor M Walker13, Lori Pierce16. 1. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: rjagsi@med.umich.edu. 2. Department of Biostatistics, University of Michigan, Ann Arbor, Michigan. 3. 21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, Michigan. 4. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Ascension Providence Hospital, Southfield, Michigan. 5. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Mercy Health Radiation Oncology, Grand Rapids, Michigan. 6. Karmanos Cancer Institute at McLaren Greater Lansing, Lansing, Michigan. 7. Beaumont Radiation Oncology, Royal Oak, Michigan. 8. Department of Radiation Oncology, Wayne State University, Detroit, Michigan; Karmanos Cancer Center, Detroit, Michigan. 9. Karmanos Cancer Institute at McLaren Macomb, Ted B. Wahby Cancer Center, Mount Clemens, Michigan. 10. Munson Medical Center, Traverse City, Michigan. 11. Karmanos Cancer Institute at McLaren Northern, Petosky, Michigan. 12. Genesys Hurley Cancer Institute, Flint, Michigan. 13. Department of Radiation Oncology, Henry Ford Health System, Jackson, Michigan. 14. Lakeland Radiation Oncology, St. Joseph, Michigan. 15. West Michigan Cancer Center, Kalamazoo, Michigan. 16. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Abstract
PURPOSE: Questions remain about whether moderately hypofractionated whole-breast irradiation is appropriate for patients with triple-negative breast cancer. METHODS AND MATERIALS: Using the prospective database of a multicenter, collaborative quality improvement consortium, we identified patients with node-negative, triple-negative breast cancer who received whole-breast irradiation with either moderate hypofractionation or conventional fractionation. Using inverse probability of treatment weighting (IPTW), we compared outcomes using the Kaplan-Meier product-limit estimation method with Cox regression models estimating the hazard ratio for time-to-event endpoints between groups. RESULTS: The sample included 538 patients treated at 18 centers in 1 state in the United States, of whom 307 received conventionally fractionated whole-breast irradiation and 231 received moderately hypofractionated whole-breast irradiation. The median follow-up time was 5.0 years (95% confidence interval [CI], 4.77-5.15 years). The 5-year IPTW estimates for freedom from local recurrence were 93.6% (95% CI, 87.8%-96.7%) in the moderate hypofractionation group and 94.4% (95% CI, 90.3%-96.8%) in the conventional fractionation group. The hazard ratio was 1.05 (95% CI, 0.51-2.17; P = .89). The 5-year IPTW estimates for recurrence-free survival were 87.8% (95% CI, 81.0%-92.4%) in the moderate hypofractionation group and 88.4% (95% CI 83.2%-92.1%) in the conventional fractionation group. The hazard ratio was 1.02 (95% CI, 0.62-1.67; P = .95). The 5-year IPTW estimates for overall survival were 96.6% (95% CI, 92.0%-98.5%) in the moderate hypofractionation group and 93.4% (95% CI, 88.7%-96.1%) in the conventional fractionation group. The hazard ratio was 0.65 (95% CI, 0.30-1.42; P = .28). CONCLUSIONS: Analysis of outcomes in this large observational cohort of patients with triple-negative, node-negative breast cancer treated with whole-breast irradiation revealed no differences by dose fractionation. This adds evidence to support the use of moderate hypofractionation in patients with triple-negative disease.
PURPOSE: Questions remain about whether moderately hypofractionated whole-breast irradiation is appropriate for patients with triple-negative breast cancer. METHODS AND MATERIALS: Using the prospective database of a multicenter, collaborative quality improvement consortium, we identified patients with node-negative, triple-negative breast cancer who received whole-breast irradiation with either moderate hypofractionation or conventional fractionation. Using inverse probability of treatment weighting (IPTW), we compared outcomes using the Kaplan-Meier product-limit estimation method with Cox regression models estimating the hazard ratio for time-to-event endpoints between groups. RESULTS: The sample included 538 patients treated at 18 centers in 1 state in the United States, of whom 307 received conventionally fractionated whole-breast irradiation and 231 received moderately hypofractionated whole-breast irradiation. The median follow-up time was 5.0 years (95% confidence interval [CI], 4.77-5.15 years). The 5-year IPTW estimates for freedom from local recurrence were 93.6% (95% CI, 87.8%-96.7%) in the moderate hypofractionation group and 94.4% (95% CI, 90.3%-96.8%) in the conventional fractionation group. The hazard ratio was 1.05 (95% CI, 0.51-2.17; P = .89). The 5-year IPTW estimates for recurrence-free survival were 87.8% (95% CI, 81.0%-92.4%) in the moderate hypofractionation group and 88.4% (95% CI 83.2%-92.1%) in the conventional fractionation group. The hazard ratio was 1.02 (95% CI, 0.62-1.67; P = .95). The 5-year IPTW estimates for overall survival were 96.6% (95% CI, 92.0%-98.5%) in the moderate hypofractionation group and 93.4% (95% CI, 88.7%-96.1%) in the conventional fractionation group. The hazard ratio was 0.65 (95% CI, 0.30-1.42; P = .28). CONCLUSIONS: Analysis of outcomes in this large observational cohort of patients with triple-negative, node-negative breast cancer treated with whole-breast irradiation revealed no differences by dose fractionation. This adds evidence to support the use of moderate hypofractionation in patients with triple-negative disease.
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