A detailed baseline audit of radiotherapy for primary breast cancer: old habits, new principles.
In the UK, fundamental changes are occurring to the organization and delivery of services to breast cancer patients, prompted by the Calman/Hine initiative and by the perception that outcomes in the UK compare unfavourably with the rest of Europe and North America. Breast cancer, being a common malignancy, has often been treated by general surgeons and oncologists rather than by site-specialized multidisciplinary teams. Outcome results for many of these surgeons and oncologists may be unknown, so it becomes difficult, in any particular centre, to quantify changes that arise from the reorganization of treatment services and adherence to new guidelines without first determining baseline results. A retrospective audit of the 350 patients with primary breast cancer who received radiotherapy in Velindre NHS Trust in 1988-1989 has been performed to provide a baseline against which future results can be measured following the adoption of agreed guidelines. The endpoints for this study were: the completeness of data; actual treatment received versus current guideline recommendations; locoregional recurrence rates; and radiation related morbidity. The adherence to agreed guidelines is likely to ensure more appropriate surgery of the primary disease and will limit radiotherapy compared with 1988-1989 in that much radiation to the axilla and Internal Mammary Chain and 'booster' treatment to the primary site will be avoided in the future. The incidence of brachial plexus neuropathy was consistent with the radiation doses used and an analysis of this data suggests that the adoption of the guidelines will probably result in the complete avoidance of this complication in the future. Likewise, it is expected that the incidence of soft tissue fibrosis, telangiectasia and pneumonitis should diminish, but this and the effect of the clinical guidelines on local recurrence rates remains to be demonstrated by future comparable audits.
Paterson
I C
IC
Velindre NHS Trust, Whitchurch, Cardiff, UK.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D018166:Health Care Reform; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000592:standards; D012189:Retrospective Studies; D006113:United Kingdom