Patterns of practice of breast cancer irradiation in the Department of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital 2010-2012.
Bunga, Antonia Mrudulata Gonzalez
Background: Globally, cancer affecting women the most is Breast cancer. Treatment may involve a combination of surgery, chemotherapy and radiotherapy. Role of Radiotherapy in breast cancer survival is often difficult to ascertain due to the number of variables prior to the patient receiving radiotherapy. However, conducting survival analysis is important for a radiation oncology department to facilitate distribution of resources to conditions that benefit most from intervention particularly for common cancers such as breast cancer. It also aids the institution in identifying potential areas for improvement. Study Design: Records of patients receiving irradiation for breast cancer reviewed retrospectively from January 2010 to December 2012 with 5 year follow up. Objectives: Determination of local control, overall survival and type of disease progression. To ascertain factors that affect overall survival of the local population. Methods: Approval was obtained. 356 patient records were randomly selected out of which 95 patient files met inclusion and exclusion criteria. Staging, Pathology, type of surgery, whether neoadjuvant or adjuvant chemo received, type of irradiation and the times between surgery, chemotherapy and radiotherapy as well as patient outcomes for 5 year follow up was collected. Data was entered into SPSS and analysed using descriptive statistics, Kaplan-Meier Survival and Cox Regression for univariate analysis. Results: Median age at diagnosis was 50 years (range 29 –81 years), 42.1% of the study population presented with Stage I and II disease. Hormone Receptor positive, HER2 positive and Triple Negative breast cancer comprised 69.5%, 17.9% and 22.1% respectively. 84.2% had invasive ductal carcinoma, 4.2% had invasive lobular carcinoma. 78.9% had a Mastectomy, 20% had Breast Conservation Surgery. 82.2% had hypofractionated irradiation. After 5-year follow-up, Local Recurrence Rate of the entire study population was 6.4%, 20.1% had Distant Metastases while 54.7% had no progression. 5-year overall survival was 71.6%, loss-to-follow-up rate was 23.5% over the 5-year period. The mortality rate was 28.4% over 5-year follow-up. Median progression free survival was not reached. Two factors found to be significant on KM analysis: number of involved nodes (HR 3.585 CI 1.14-11.273 p=0.029) and inner quadrant tumours (HR 2.419 CI 1.062-5.511 p=0.035). 35.8% of the study population received radiotherapy within 8 weeks from preceding intervention. Conclusion and Recommendation: Hypofractionated radiotherapy has favourable outcomes in our setting. The loss-to-follow-up rate makes analysis reliable for descriptive statistics but not reliable in survival analysis. Establishing a departmental database and regularly collecting information on patient outcomes to facilitate timely data analysis is recommended. Provision of incentives to patients for attending follow-up clinics to reduce loss-to-follow-up. Careful selection of patients to receive radiotherapy will aid in improving outcomes. Identifying patients needing radiotherapy at Multidisciplinary Team Meetings to plan scheduling ahead of time
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine, 2021