title: Radiotherapy for invasive breast cancer in North America and Europe: results of a survey.
abstract: OBJECTIVE
  To document and explain the current radiotherapeutic management of invasive breast cancer in North America and Europe. We also identified a number of areas of agreement, as well as controversy, toward which additional clinical research should be directed.
  
  
  METHODS
  An original survey questionnaire was developed to assess radiation oncologists' self-reported management of breast cancer. The questionnaire was administered to physician members of the American Society for Therapeutic Radiology and Oncology and the European Society for Therapeutic Radiology and Oncology. We present the results of the comparative analysis of 702 responses from North America and 435 responses from Europe.
  
  
  RESULTS
  Several areas of national and international controversy were identified, including the selection of appropriate candidates for postmastectomy radiation therapy (RT) and the appropriate management of the regional lymph nodes after mastectomy, as well as after lumpectomy. Only 40.7% and 36.1% of respondents would use postmastectomy RT in patients with 1-3 positive lymph nodes in North America and Europe, respectively. Sentinel lymph node biopsy was offered more frequently by North American than European respondents (p <0.0001) and more frequently by academic than nonacademic respondents in North America (p < 0.05). The average radiation fraction size was larger in Europe than in North America (p < 0.01). European respondents offered RT to the internal mammary chain more often than did the North American respondents (p < 0.001). North American respondents were more likely to offer RT to the supraclavicular fossa (p < 0.001) and axilla (p < 0.01).
  
  
  CONCLUSIONS
  Marked differences were found in physician opinions regarding the management of breast cancer, with statistically significant international differences in patterns of care. This survey highlighted areas of controversy, providing support for international randomized trials to optimize the RT management of invasive breast cancer.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ceilley
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.forename: Saveli
authors.initials: S
authors.lastname: Goldberg
authors.forename: Laurent
authors.initials: L
authors.lastname: Grignon
authors.forename: Lisa
authors.initials: L
authors.lastname: Kachnic
authors.forename: Simon
authors.initials: S
authors.lastname: Powell
authors.forename: Alphonse
authors.initials: A
authors.lastname: Taghian
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002170:Canada; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015182:Lymphatic Irradiation; D015412:Mastectomy, Segmental; D010818:Practice Patterns, Physicians'; D011879:Radiotherapy Dosage; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014481:United States