title: Utilization of accelerated partial breast irradiation for ductal carcinoma in situ, 2003-2011: report from the national cancer database.
abstract: BACKGROUND
  Data on recent trends and correlates of utilization for accelerated partial breast irradiation using brachytherapy (APBI-b) for ductal carcinoma in situ (DCIS) are lacking.
  
  
  METHODS
  This study included 113,841 DCIS patients from the National Cancer Data Base, of whom 8,709 (6.5 %) underwent APBI-b and 105,132 (93.5 %) underwent external beam irradiation after lumpectomy between 2003 and 2011. Trends in APBI-b use, American Society for Radiation Oncology (ASTRO) guideline concordance, and independent factors related to APBI-b use were examined.
  
  
  RESULTS
  APBI-b use increased from 1.6 % in 2003 to 11.9 % in 2008 and then decreased to 9.1 % in 2011 (p < 0.001). Before 2009, 24.6 % of patients undergoing APBI-b were in the ASTRO guideline 'unsuitable' category, but this proportion decreased to 14.6 % after 2009 (p < 0.001). When adjusting for year of diagnosis, patient, tumor, and facility factors, the four strongest independent factors for APBI-b use were year of diagnosis followed by facility location, facility volume, and facility type. APBI-b use was highest in the East South Central census region (13.1 %) and lowest in the New England region (2.0 %). A statistically significant interaction was identified between facility type and volume. Patients in community cancer programs of large volume were more likely to receive APBI-b, whereas patients in larger academic programs were less likely to receive APBI-b.
  
  
  CONCLUSIONS
  APBI-b for DCIS decreased from 2008 to 2011. After year of diagnosis, facility factors were most strongly associated with APBI-b use as opposed to patient and tumor factors. Reasons for these trends are multifactorial and deserve further study.
authors.affiliation: Department of Surgery, NorthShore University Health System, Evanston, IL, USA, kyao@northshore.org.
authors.forename: Katharine
authors.initials: K
authors.lastname: Yao
authors.forename: Tomasz
authors.initials: T
authors.lastname: Czechura
authors.forename: Erik
authors.initials: E
authors.lastname: Liederbach
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.forename: Catherine
authors.initials: C
authors.lastname: Pesce
authors.forename: Arif
authors.initials: A
authors.lastname: Shaikh
authors.forename: David P
authors.initials: DP
authors.lastname: Winchester
authors.forename: Dezheng
authors.initials: D
authors.lastname: Huo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000532:radiotherapy*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000532:radiotherapy*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011879:Radiotherapy Dosage