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Article

Cross-Border Referral for Early Breast Cancer: An Analysis of Radiation Fractionation Patterns

1
Department of Radiation Oncology, Juravinski Cancer Centre; and Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
2
Supportive Cancer Care Research Unit, McMaster University, Hamilton, ON L8S 4L8, Canada
3
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON L8S 4L8, Canada
4
Department of Radiation Medicine, Roswell Park Cancer Institute; and Department of Radiation Oncology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA
5
Research Department, St. Joseph’s Care Group; and Centre for Education and Research on Aging and Health, Lakehead University, Thunder Bay, ON P7B 5E1, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2006, 13(4), 124-129; https://doi.org/10.3390/curroncol13040013
Submission received: 12 May 2006 / Revised: 3 June 2006 / Accepted: 4 July 2006 / Published: 1 August 2006

Abstract

Because of increasing waiting times for adjuvant radiation in the province of Ontario, patients from one Canadian centre were referred to two centres in the United States. This situation provided an opportunity to compare radiation practices. We performed a retrospective review of radiation prescribed to patients following breast-conserving surgery for invasive breast cancer. Patients with positive margins, 4 or more positive lymph nodes, recurrent disease, or large tumours (>5 cm) were excluded. For comparison, we reviewed a random sample of similar patients treated at the Canadian centre during the same period. A total of 120 referred and 217 non-referred patients were eligible for comparison. The analysis included 98 pairs of patients (N = 196), fully matched on age, nodal status, T stage, grade, and estrogen receptor (ER) status. Mean patient age was 60.7 years. The median total dose and number of fractions differed between centres [6040 cGy in 32 fractions (United States) vs. 4250 cGy in 16 fractions (Canadian), both p < 0.001). Boost was used more often in the United States (97% vs. 9%, p < 0.001). Variation in prescribing patterns was seen. In the United States, seven different schedules for whole-breast irradiation were used; at the Canadian centre, two schedules were prescribed. Predicted radiobiologic effects of these schedules were calculated to be similar. Differences in fractionation patterns were observed between and within U.S. and Canadian centres. Such variability is likely to affect patient convenience and resource utilization. Although patient selection, referring surgeon, and change in policies may account for some of the observed differences, further research is necessary to better understand the causes.
Keywords: breast cancer; cross-border referral; fractionation; patterns of practice; radiotherapy breast cancer; cross-border referral; fractionation; patterns of practice; radiotherapy

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MDPI and ACS Style

Dayes, I.S.; Whelan, T.J.; Julian, J.A.; Kuettel, M.R.; Regmi, D.; Okawara, G.S.; Patel, M.; Reiter, H.I.; Dubois, S. Cross-Border Referral for Early Breast Cancer: An Analysis of Radiation Fractionation Patterns. Curr. Oncol. 2006, 13, 124-129. https://doi.org/10.3390/curroncol13040013

AMA Style

Dayes IS, Whelan TJ, Julian JA, Kuettel MR, Regmi D, Okawara GS, Patel M, Reiter HI, Dubois S. Cross-Border Referral for Early Breast Cancer: An Analysis of Radiation Fractionation Patterns. Current Oncology. 2006; 13(4):124-129. https://doi.org/10.3390/curroncol13040013

Chicago/Turabian Style

Dayes, Ian S., T. J. Whelan, J. A. Julian, M. R. Kuettel, D. Regmi, G. S. Okawara, M. Patel, H. I. Reiter, and S. Dubois. 2006. "Cross-Border Referral for Early Breast Cancer: An Analysis of Radiation Fractionation Patterns" Current Oncology 13, no. 4: 124-129. https://doi.org/10.3390/curroncol13040013

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