title: Practical Implications of the Publication of Consensus Guidelines by the American Society for Radiation Oncology: Accelerated Partial Breast Irradiation and the National Cancer Data Base.
abstract: OBJECTIVE
  To examine utilization trends of accelerated partial breast irradiation (APBI) in the American College of Surgeons' National Cancer Database and changes in APBI use after the 2009 publication of the American Society for Radiation Oncology (ASTRO) guidelines.
  
  
  METHODS
  A total of 399,705 women were identified who were diagnosed from 2004 to 2011 with nonmetastatic invasive breast cancer or ductal carcinoma in situ who were treated with breast-conserving surgery and radiation therapy to the breast. Patients were divided by the type of treatment received (whole breast irradiation or APBI) and by suitability to receive APBI as defined by the ASTRO guidelines. Logistic regression was applied to study APBI use overall and within guideline categorization, and a multivariable model was created to determine predictors of treatment with brachytherapy-based APBI based on guideline categorization.
  
  
  RESULTS
  For all patients, APBI use increased, from 3.8% in 2004 to 10.6% in 2011 (P<.0001). Overall rates of APBI utilization were higher among "suitable" than "cautionary"/"unsuitable" patients (14.8% vs 7.1%, P<.0001). The majority of APBI treatment was delivered using brachytherapy, for which use peaked in 2008. Starting in 2009, among "suitable" patients, utilization of APBI via brachytherapy plateaued, whereas for "cautionary"/"unsuitable" patients, treatment with brachytherapy-based APBI declined and then plateaued.
  
  
  CONCLUSIONS
  Use of APBI across all patient groups increased from 2004 through 2008. After publication of the ASTRO APBI guidelines in 2009, rates of brachytherapy-based APBI treatment plateaued among "suitable" patients and declined and then plateaued among "cautionary"/"unsuitable" patients. Our study highlights how large national databases can be used to assess national trends in radiation use in response to the publication of guidelines.
authors: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: sfshaitelman@mdanderson.org.
authors: Simona F
authors: SF
authors: Shaitelman
authors: Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Heather Y
authors: HY
authors: Lin
authors: Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Benjamin D
authors: BD
authors: Smith
authors: Department of Breast Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Yu
authors: Y
authors: Shen
authors: Department of Breast Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Isabelle
authors: I
authors: Bedrosian
authors: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Gary D
authors: GD
authors: Marsh
authors: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Elizabeth S
authors: ES
authors: Bloom
authors: Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI.
authors: Frank A
authors: FA
authors: Vicini
authors: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Thomas A
authors: TA
authors: Buchholz
authors: Department of Breast Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Gildy V
authors: GV
authors: Babiera
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000706:statistics & numerical data / Q000639:trends; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy* / Q000601:surgery; D032921:Consensus; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011643:Publishing; D018787:Radiation Oncology / Q000592:standards*; D011878:Radiotherapy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D012044:Regression Analysis; D012955:Societies, Medical; D014481:United States