title: Epidemiologic study of compliance to postmastectomy radiation therapy guidelines in breast cancer patients in China between 1999 and 2008.
abstract: OBJECTIVE
  To evaluate compliance with postmastectomy radiation therapy (PMRT) guidelines in breast cancer patients in China over a 10-year period.
  
  
  METHODS
  A hospital-based, nationwide, multicenter retrospective epidemiologic study of primary breast cancer in women was conducted. Seven first-class, upper-level hospitals from different geographic regions of China were selected. One month was randomly selected to represent each year from 1999-2008 in every hospital. All inpatient cases within the selected months were reviewed and demographic, clinical, and pathologic characteristics and treatment patterns were collected. Patients enrolled in this study had to meet the following inclusion criteria: (1) treated with mastectomy and axillary dissection; (2) information regarding whether or not they received postmastectomy radiation therapy was available; and (3) information about staging was available. Patients were divided into 3 groups based on National Comprehensive Cancer Network guidelines. Utilization of PMRT in each group was analyzed and compared between different years and different hospitals.
  
  
  RESULTS
  A total of 2310 patients were analyzed. There were 643 (27.8%) patients in the PMRT recommended group, 557 (24.1%) patients in the controversial group, and 1110 (48.1%) patients in the nonrecommended group. PMRT was used in 48.8% of patients in the recommended group, 15.6% in the controversial group, and 5.7% in the nonrecommended group. There was a trend toward increasing use of radiation therapy in the recommended and controversial groups from 1999-2008. The use of PMRT in the nonrecommended group remained relatively stable from 1999-2008. Fewer positive nodes and nonreceipt of chemotherapy or hormone therapy were associated with underuse of PMRT in the recommended group. In the controversial group, a higher ratio of positive nodes was associated with use of PMRT.
  
  
  CONCLUSIONS
  There is an apparent underuse of PMRT in the PMRT recommended group. Efforts should be made to improve the compliance to PMRT guidelines.
authors.affiliation: Department of Radiation Oncology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Shu-Lian
authors.initials: SL
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. Electronic address: yexiong@yahoo.com.
authors.forename: Ye-Xiong
authors.initials: YX
authors.lastname: Li
authors.affiliation: Department of Breast Surgery, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Bao-Ning
authors.initials: BN
authors.lastname: Zhang
authors.affiliation: Department of Cancer Epidemiology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Cancer Epidemiology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Jin-Hu
authors.initials: JH
authors.lastname: Fan
authors.affiliation: Department of Cancer Epidemiology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Pang
authors.affiliation: Department of Medical Oncology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Pin
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Shan
authors.initials: S
authors.lastname: Zheng
authors.affiliation: Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, China.
authors.forename: Hong-Jian
authors.initials: HJ
authors.lastname: Yang
authors.affiliation: Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
authors.forename: Xiao-Ming
authors.initials: XM
authors.lastname: Xie
authors.affiliation: Department of Breast-thyroid Surgery, Xiangya Sencod Hospital, Central South University, Changsha, China.
authors.forename: Zhong-Hua
authors.initials: ZH
authors.lastname: Tang
authors.affiliation: Department of Breast Surgery, the Second People's Hospital of Sichuan Province, Chengdu, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Jia-Yuan
authors.initials: JY
authors.lastname: Li
authors.affiliation: Department of Oncosurgery, the First Affiliated Hospital of Medical College, Xi'an JiaoTong University, Xi'an, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: He
authors.affiliation: Department of Cancer Epidemiology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao