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Cross-Border Referral for Early Breast Cancer: An Analysis of Radiation Fractionation Patterns
Abstract
Introduction: Due to increasing waiting times for adjuvant radiation in the province of Ontario, patients from one Canadian (CN) centre were referred to two centres in the United States (US). This provided the opportunity to compare radiation practices.
Materials and methods: A retrospective review was performed of radiation prescribed to patients following breast-conserving surgery for invasive breast cancer. Patients with positive margins, ³ 4 positive lymph nodes, recurrent disease or large tumors (>5 cm) were excluded. A random sample of similar patients treated at the CN centre during the same time period was reviewed for comparison.
Results: 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 ER status. Mean patient age was 60.7 years. The median total dose and number of fractions differed between centres: 6040 (US) vs. 4250 (CN) cGy in 32 vs. 16 fractions respectively (both p
Materials and methods: A retrospective review was performed of radiation prescribed to patients following breast-conserving surgery for invasive breast cancer. Patients with positive margins, ³ 4 positive lymph nodes, recurrent disease or large tumors (>5 cm) were excluded. A random sample of similar patients treated at the CN centre during the same time period was reviewed for comparison.
Results: 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 ER status. Mean patient age was 60.7 years. The median total dose and number of fractions differed between centres: 6040 (US) vs. 4250 (CN) cGy in 32 vs. 16 fractions respectively (both p