Abstract P3-12-10: Utilization patterns and temporal trends of internal mammary nodal irradiation (IMNI) at a tertiary cancer centre
Notice bibliographique
Résumé
Abstract Purpose: Despite data from multiple randomized trials, the role and uptake of internal mammary nodal irradiation (IMNI) is variable. This study was designed to quantify the rates and determinants of IMNI at a tertiary cancer centre. Methods: Treatment records of consecutively treated breast cancer (BC) patients receiving adjuvant locoregional (LR) radiotherapy (RT) from January 1, 2012 to October 31, 2017 was studied. LR-RT and use of IMNI as a function of clinicopathological factors, use of deep inspiratory breath-hold (DIBH) and dosimetric parameters were retrieved. Patients were divided into two groups:Group1 received LR-RT that included the IMN's, supraclavicular (SCLV) ± axillary regions,Group2 received LR-RT directed only to the SCLV±axillary areas. For the purpose of utilization analysis and temporal trends, early(2012-2015) and late(2016-2017) cohorts were examined based on the year of RT delivery. To determine if the use of IMNI was dependent on BC risk, we defined 3 risk categories:1) pT1/2, N0); 2)pT1/2, N1; and 3) pT3/4, N2/3 disease. Differences between the risk categories and groups were evaluated using chi-square/ Fisher's and Mann Whitney test for categorical and continuous variables, respectively. Univariable and multivariable logistic regression analysis was done to determine factors associated with the receipt of IMNI. Results:A total of 1566 patients met eligibility (Group 1=376; Group 2=1190). Of these patients, the percentage receiving LR-RT remained constant (17%) over the study period but the proportion of patients receiving IMNI increased significantly each year (p<0.0001), and was higher in the late vs. early treatment cohort (55% vs 8%, p<0.0001).On univariable analysis, younger age, LVI positivity, medial/central location, increasing stage, PR negativity, mastectomy, axillary dissection ,receipt of chemotherapy and increasing number of positive nodes had higher odds of receiving IMNI. Radiation oncologists with < or ≥5 years of practice was predictive of IMNI (31.3% vs 20.5%, p<0.0001),staff having <5years in practice being more likely to recommend IMNI. The distribution of patients in the different risk categories was similar between Groups 1 and 2 (p=0.097), and identified that the majority of patients receiving IMNI were in risk category 2(83%). Further comparison of risk categories suggested that the odds of receiving IMNI was lower in risk category 3 vs. category 1 (p=0.033). On multivariable analysis, decreasing age age (p=<0.001) , medial quadrant(p=0.0026),PR negative(p=0.0011), mastectomy(p=0.0055) , increasing nodal positivity (p<0.0001)and late RT cohort (p=0.001) had increased odds of IMNI. Overall use of DIBH was significantly higher in those receiving IMNI (45% vs 26%, p<0.0001). Mean heart (2.2vs1.7Gy, p<0.0001) and total lung doses (7.8vs6.6Gy,p<0.0001) were also significantly higher with IMNI. Conclusion: There was a significant increase in utilization of IMNI from 2012 to 2017. Younger age, medial location, PR negativity and increasing number of positive nodes predicted for receipt of IMNI. Staff with<5years in practice were more likely to recommend LR-RT that included the IMNs. The use of DIBH significantly increased with IMNI and allowed for acceptable dosimetric constraints. Citation Format: Misra S, Lee G, Maganti M, Koch CA. Utilization patterns and temporal trends of internal mammary nodal irradiation (IMNI) at a tertiary cancer centre [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-10.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».