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Open Access 01-09-2021 | Breast Cancer | Original Article

Impact of guideline changes on adoption of hypofractionation and breast cancer patient characteristics in the randomized controlled HYPOSIB trial

Authors: Dr. David Krug, Reinhard Vonthein, Andreas Schreiber, Alexander D. Boicev, Jörg Zimmer, Reinhold Laubach, Nicola Weidner, Stefan Dinges, Matthias Hipp, Ralf Schneider, Evelyn Weinstrauch, Thomas Martin, Juliane Hörner-Rieber, Denise Olbrich, Alicia Illen, Nicole Heßler, Inke R. König, Kathrin Dellas, Jürgen Dunst

Published in: Strahlentherapie und Onkologie | Issue 9/2021

Abstract

Purpose

Hypofractionated radiotherapy is the standard of care for adjuvant whole breast radiotherapy (RT). However, adoption has been slow. The indication for regional nodal irradiation has been expanded to include patients with 0–3 involved lymph nodes. We investigated the impact of the publication of the updated German S3 guidelines in 2017 on adoption of hypofractionation and enrollment of patients with lymph node involvement within a randomized controlled phase III trial.

Methods

In the experimental arm of the HYPOSIB trial (NCT02474641), hypofractionated RT with simultaneous integrated boost (SIB) was used. In the standard arm, RT could be given as hypofractionated RT with sequential boost (HF_seq), normofractionated RT with sequential boost (NF_seq), or normofractionated RT with SIB (NF_SIB). The cutoff date for the updated German S3 guidelines was December 17, 2017. Temporal trends were analyzed by generalized linear regression models. Multiple logistic regression models were used to investigate the influence of time (prior to/after guideline) and setting (university hospital/other institutions) on the fractionation patterns.

Results

Enrollment of patients with involved lymph nodes was low throughout the trial. Adoption of HF_seq increased over time and when using the guideline publication date as cutoff. Results of the multiple logistic regressions showed an interaction between time and setting. Furthermore, the use of HF_seq was significantly more common in university hospitals.

Conclusion

The use of HF_seq in the standard arm increased over the course of the HYPOSIB trial and after publication of the S3 guideline update. This was primarily driven by patients treated in university hospitals. Enrolment of patients with lymph node involvement was low throughout the trial.

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Title: Impact of guideline changes on adoption of hypofractionation and breast cancer patient characteristics in the randomized controlled HYPOSIB trial
Authors: Dr. David Krug
Reinhard Vonthein
Andreas Schreiber
Alexander D. Boicev
Jörg Zimmer
Reinhold Laubach
Nicola Weidner
Stefan Dinges
Matthias Hipp
Ralf Schneider
Evelyn Weinstrauch
Thomas Martin
Juliane Hörner-Rieber
Denise Olbrich
Alicia Illen
Nicole Heßler
Inke R. König
Kathrin Dellas
Jürgen Dunst
Publication date: 01-09-2021
Publisher: Springer Berlin Heidelberg
Keywords: Breast Cancer
Breast Cancer
Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 9/2021
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-020-01730-9

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Impact of guideline changes on adoption of hypofractionation and breast cancer patient characteristics in the randomized controlled HYPOSIB trial

Abstract

Purpose

Methods

Results

Conclusion

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Abstract

Purpose

Methods

Results

Conclusion

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