The 1993-94 patterns of care process survey for breast irradiation after breast-conserving surgery - Comparison with the 1992 Standard for Breast Conservation Treatment
B. Shank et al., The 1993-94 patterns of care process survey for breast irradiation after breast-conserving surgery - Comparison with the 1992 Standard for Breast Conservation Treatment, INT J RAD O, 48(5), 2000, pp. 1291-1299
Citations number
4
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Onconogenesis & Cancer Research
Journal title
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Purpose: To determine the patterns of evaluation and treatment in the U.S.
of women with early breast cancer treated with breast-conserving surgery an
d irradiation in 1993-94, and to compare these with a similar survey in 198
3 and with the 1992 Standard for Breast Conservation Treatment.
Methods and Materials: In 1995-96, 727 randomly selected records of eligibl
e patients treated from 1993-94 at 62 facilities representative of 3 practi
ce types were reviewed.
Results: Compared with the Process Survey (PS) in 1983, patients in the 199
3-94 study had an older age distribution. In the current study, 70% of pati
ents were greater than or equal to 50 years of age, and 69% were post-menop
ausal, compared,vith 59% greater than or equal to 50 years of age and 49% p
ost-menopausal in 1983 (p = 0.0087 and < 0.001, respectively). Work-up and
evaluation in the 1993-94 PS were closely aligned with the standard and wer
e considerably improved compared with 1983. In the 1983 study, 77% of patie
nts underwent mammography, as compared to 97% in the 1993-94 study. In 1983
, pathological size documentation was performed in 83% of patients; in 1993
-94, this was performed in 95% of patients. An estrogen receptor evaluation
was performed in 36% of patients in 1983; in 1993-94, that increased to 76
%. In 1983, 28% of patients underwent progesterone receptor evaluation; in
1993-94, this increased to 72%. Only 3% of patients in 1993-94 were enrolle
d in a clinical trial. Radiation treatment parameters closely adhered to st
andard recommendations, improving substantially from 1983. In 1983, wedge o
r compensator use was recommended for 64% of patients; in 1993-94, for 95%
of patients. In 1983, 4-8 MV photons were recommended for breast treatment
in 67% of patients; in 1993-94, 90%. In 1983, bolus was avoided in 75% of p
atients; in 1993-94, in 94%. In 1983, the recommended breast dose for 89% o
f patients was 45-50 Gy (44-51 Gy in PS); in 1993-94 this had increased to
99% of patients. In 1983, electrons were recommended for primary site boost
in 70% of patients; in 1993-94, for 94% of patients.
Conclusion: There was an extensive shift to adherence to the 1992 standard
in 1993-94, compared with the 1983 PS, although there is room for improveme
nt in some areas. (C) 2000 Elsevier Science Inc.