title: Utilization trend and regimens of hypofractionated whole breast radiation therapy in the United States.
abstract: We aimed to evaluate the adoption of hypofractionated whole-breast irradiation (HF-WBI) over time and factors related to its adoption for patients undergoing lumpectomy. We also examined whether HF-WBI can increase the overall use of radiotherapy.
  
  
  
  Using data from the National Cancer Database between 2004 and 2013, we identified 528,051 invasive and 190,431 ductal carcinoma in situ (DCIS) patients who underwent lumpectomy. HF-WBI was defined as 2.5-3.33 Gy/fraction to the breast, whereas conventional therapy (CF-WBI) was defined as 1.8-2.0 Gy/fraction.
  
  
  
  The usage of HF-WBI among invasive cancer patients increased from 0.7% in 2004 to 15.6% in 2013, and among DCIS patients, HF-WBI increased from 0.4% in 2004 to 13.4% in 2013. However, these changes only lead to a slight increase in the overall use of radiotherapy. Interestingly, for DCIS patients who lived ≥50 miles from hospitals, the uptake of HF-WBI translated to a moderate increase in the overall use of radiotherapy (58% in 2004 to 63% in 2013). Multivariable logistic regression showed that older age, node-negative or smaller tumor, living in mountain states, rural area, or ≥50 miles from hospitals, and treated in large or academic cancer centers were associated with elevated HF-WBI use. The median duration of finishing radiotherapy for HF-WBI was 26 days, compared to 47 days for CF-WBI.
  
  
  
  Although HF-WBI can save 3 weeks of patient time, its adoption remained low in the US. There was only a slight increase in the overall use of radiotherapy among patients undergoing lumpectomy.
authors.affiliation: Department of Radiation & Cellular Oncology, University of Chicago, Chicago, IL, USA.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Hasan
authors.affiliation: Department of Radiation & Cellular Oncology, University of Chicago, Chicago, IL, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Waller
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Katharine
authors.initials: K
authors.lastname: Yao
authors.affiliation: Department of Radiation & Cellular Oncology, University of Chicago, Chicago, IL, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Chmura
authors.affiliation: Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC 2000, Chicago, IL, 60637, USA. dhuo@health.bsd.uchicago.edu.
authors.forename: Dezheng
authors.identifier: 0000-0002-4041-1678
authors.initials: D
authors.lastname: Huo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care; D011182:Postoperative Care; D000069473:Radiation Dose Hypofractionation; D018714:Radiotherapy, Adjuvant / Q000379:methods; D047368:Tumor Burden; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Breast cancer; Hypofractionated radiation therapy; Regimens; Trend