title: [Compliance of patients concerning recommended radiotherapy in breast cancer :  Association with recurrence, age, and hormonal therapy].
abstract: OBJECTIVE
  In this study, we investigated how often guidelines for radiation therapy in patients with breast cancer are not complied with, which patient group is mostly affected, and how this influences local recurrence.
  
  
  METHODS
  All patients (n = 1,903) diagnosed between November 2003 and December 2008 with primary invasive or intraductal breast cancer in the interdisciplinary breast center of the Charité Hospital Berlin were included and followed for a median 2.18 years.
  
  
  RESULTS
  Patients who, in contrast to the recommendation of the interdisciplinary tumor board, did not undergo postoperative radiation experienced a fivefold higher local recurrence rate (p < 0.0005), corresponding to a 5-year locoregional recurrence-free survival of 74.5% in this group. The 5-year locoregional recurrence-free survival of patients following the recommendations was 93.3%. Guideline compliance was dependent on age of patients, acceptance of adjuvant hormonal treatment or chemotherapy, and increased diameter of the primary tumor. Multiple logistic regression analysis showed an association between compliance and age or hormonal therapy.
  
  
  CONCLUSIONS
  In order to avoid local recurrence patients should be motivated to comply with guideline driven therapy. Since a higher number of local recurrences is observed in health services research compared to clinical research, studies on the value of adjuvant treatment following local recurrence should be performed.
authors.affiliation: Brustzentrum, Klinik für Gynäkologie, Charité am Campus Benjamin Franklin und am Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Deutschland. klaus-juergen.winzer@charite.de
authors.forename: K-J
authors.initials: KJ
authors.lastname: Winzer
authors.forename: C
authors.initials: C
authors.lastname: Gruber
authors.forename: H
authors.initials: H
authors.lastname: Badakhshi
authors.forename: M
authors.initials: M
authors.lastname: Hinkelbein
authors.forename: C
authors.initials: C
authors.lastname: Denkert
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D020249:Hormone Replacement Therapy / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000532:radiotherapy*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011878:Radiotherapy / Q000592:standards* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult