title: Accelerated partial breast irradiation via brachytherapy: a patterns-of-care analysis with ASTRO consensus statement groupings.
abstract: OBJECTIVE
  The 2002 Food and Drug Administration approval of the MammoSite catheter (Hologic, Inc., Beford, MA) led to a surge of interest in accelerated partial breast irradiation (APBI). Until recently, guidelines as to the optimal candidates for this treatment were unavailable. We performed a patterns-of-care analysis for patients undergoing breast brachytherapy and compared these results with the American Society for Radiation Oncology (ASTRO) consensus statement.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database was used to examine female breast cancer patients treated with brachytherapy between 2002 and 2007. The patients were then categorized into suitable, cautionary, and unsuitable groups based on the ASTRO guidelines.
  
  
  RESULTS
  We identified 4172 female breast cancer patients treated within the stated years. The number of brachytherapy cases increased nearly 10-fold over the time period studied from 163 in 2002 to 1427 in 2007 (p<0.0001). Patients with data missing were excluded, leaving a total of 3593 patients available for analysis. The mean patient age was 64 years. Most patients had small (<2cm in 80.9%) estrogen receptor-positive (86.7%) invasive (88.6%) tumors. The percentage of patients treated for ductal carcinoma in situ increased with time (p<0.001), whereas the percentage of patients treated with positive lymph nodes decreased with time (p<0.001). Using the data available, 1369 (38.1%), 1563 (43.5%), and 661 (18.3%) patients were characterized as suitable, cautionary, and unsuitable, respectively.
  
  
  CONCLUSIONS
  More than 60% of patients who received APBI via brachytherapy would fall into the ASTRO cautionary or unsuitable groupings. This is the largest patterns-of-care analysis for APBI patients and serves as a baseline for future comparison.
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical System, Baltimore, MD 21201, USA. zhusain@umm.edu
authors.forename: Zain A
authors.initials: ZA
authors.lastname: Husain
authors.forename: Usama
authors.initials: U
authors.lastname: Mahmood
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hanlon
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Neuner
authors.forename: Robert
authors.initials: R
authors.lastname: Buras
authors.forename: Katherine
authors.initials: K
authors.lastname: Tkaczuk
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Feigenberg
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D001918:Brachytherapy / Q000379:methods; D001940:Breast / Q000528:radiation effects; D001943:Breast Neoplasms / Q000532:radiotherapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018426:SEER Program; D016896:Treatment Outcome; D003245:Consensus Statements as Topic