Patterns of radiotherapy for early breast cancer in Northern Italy compared with European and national standards

Purpose: To assess the current practice of early breast cancer (EBC) post-o perative irradiation in Northern Italy and to evaluate its conformance with European standards and recently defined national guidelines. Materials and methods: Fifty Radiotherapy departments in Northern Italy rec eived a questionnaire assessing parameters on pre-treatment evaluation of p atients, on preparation, prescription and execution phases of irradiation ( XRT), on surgery-XRT-chemotherapy integration and on follow-up. The analysi s of collected information was compared with both the 1991 EORTC-EUSOMA gui delines and the 1997 AIRO (Italian Association for Radiation Oncology) mini mal requirements on EBC post-operative irradiation. Results: Thirty-nine out of 50 (78%) departments answered the questionnaire . All treat T1-T2 tumours, after tumourectomy or, mostly, quadrantectomy. T he mean interval between surgery and XRT is 45 +/- 14 days. Chemotherapy is delivered concurrently in 70% of departments, CTV is represented by residu al mammary gland in 100% of cases, while 38% and 52% of departments occasio nally treat internal mammary and axillary or supra-clavicular nodes, respec tively. Total dose delivered to the whole breast is 46-50 Gy in 98% (1.8-2 Gy/fraction). The tumour bed is boosted in 79% of cases. An immobilization device is used in 28% of cases CTV is clinically localized in 62% of patien ts. Tangential fields are simulated in 85% of centres, with film storage in 78% of cases. Co-60 units are used in 58% and/or 4-6 MV X-rays in 70% of c entres, mostly utilizing beam modifiers. Computerized treatment planning is performed in 95% of cases. Fifty-five percent of departments prescribe the dose at the ICRU point. Portal films are routinely taken in 50% of cases. Boost irradiation is mainly performed using external XRT. Lastly, acute and late side effects and cosmesis are respectively evaluated in 100%, 98% and 90% of centres. Conclusions: Results on current practice in Northern Italy generally show a good conformance with European standards. However, some variables related to treatment prescription, simulation and treatment planning need to be sta ndardized. This set of information was largely utilized by the AIRO to defi ne national guidelines adapted to the Italian resources and situation. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.