title: Practice patterns in the delivery of radiation therapy after mastectomy among the University of California Athena Breast Health Network.
abstract: BACKGROUND
  Practice patterns vary with the planning and delivery of PMRT. In our investigation we examined practice patterns in the use of chest wall bolus and a boost among the Athena Breast Health Network (Athena).
  
  
  METHODS
  Athena is a collaboration among the 5 University of California Medical Centers that aims to integrate clinical care and research. From February 2011 to June 2011, all physicians specializing in the multidisciplinary treatment of breast cancer were invited to take a Web-based practice patterns survey. Sixty-two of the 239 questions focused on radiation therapy practice environment, decision-making processes, and treatment management, including the use of a bolus or boost in PMRT.
  
  
  RESULTS
  Ninety-two percent of the radiation oncologists specializing in breast cancer completed the survey. All of the responders use a material to increase the surface dose to the chest wall during PMRT. Materials used included brass mesh, commercial bolus, and custom-designed wax bolus. Fifty percent used tissue equivalent superflab bolus. Fifty-five percent of the respondents routinely use a boost to the chest wall in PMRT. Eighteen percent give a boost depending on the margin status, and 3 of 11 (27%) do not use a boost.
  
  
  CONCLUSIONS
  Our investigation documents practice pattern variation for the use of a PMRT boost and the use of chest wall bolus among the University of California breast cancer radiation oncologists. Further understanding of the practice pattern variation will help guide clinicians in our cancer centers to a more uniform approach in the delivery of PMRT.
authors.affiliation: Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA. Electronic address: jyoti.mayadev@ucdmc.ucdavis.edu.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Mayadev
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, San Diego, CA.
authors.forename: John
authors.initials: J
authors.lastname: Einck
authors.affiliation: Athena Breast Health Network, San Francisco, CA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Elson
authors.affiliation: Department of Medicine (Hematology/Oncology), University of California Helen Diller Comprehensive Cancer Center, San Francisco, CA.
authors.forename: Hope
authors.initials: H
authors.lastname: Rugo
authors.affiliation: Department of Surgical Oncology, Duke University, Durham, NC.
authors.forename: Shelley
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Department of Surgical Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Richard
authors.initials: R
authors.lastname: Bold
authors.affiliation: Department of Radiation Oncology, University of California Irvine, Orange, CA.
authors.forename: Parima
authors.initials: P
authors.lastname: Daroui
authors.affiliation: Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, UCLA Medical Center, Santa Monica, Santa Monica, CA.
authors.forename: Susan
authors.initials: S
authors.lastname: McCloskey
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, San Diego, CA.
authors.forename: Catheryn
authors.initials: C
authors.lastname: Yashar
authors.affiliation: Athena Breast Health Network, San Francisco, CA.
authors.forename: Danny
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, University of California Helen Diller Comprehensive Cancer Center, San Francisco, CA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Fowble
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*; D002140:California / Q000453:epidemiology; D019058:Community Networks; D003657:Decision Making; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*
keywords: Bolus; Boost; Postmastectomy; Radiation; Treatment planning