title: The Rise and Fall of Accelerated Partial Breast Irradiation via Brachytherapy in a Single Institution.
abstract: Accelerated partial breast irradiation via brachytherapy (APBI-b) is offered as an alternative to whole breast irradiation (WBI) for selected patients with breast cancer. This study evaluates our clinical experience with APBI-b to identify the reasons for decreased clinical utilization in recent years. We performed an analysis of the prospective database of breast cancer patients treated with APBI-b between 2004 and 2013. During that time, 245 patients received APBI-b, most having stage I (77%) or stage 0 (20%) breast cancer. Since 2004, the number of APBI-b cases per year rose to 49 in 2009, declining thereafter to 14 in 2013 (P < 0.001). The APBI-b case volume dropped in 2010 following the publication of the American Society of Radiation Oncology (ASTRO) consensus guidelines in 2009. After 2009 fewer unsuitable cases received APBI-b (11% vs. 4%,P = 0.1).
  
  
  CONCLUSIONS
  The clinical utilization of APBI-b has decreased after the publication of consensus guidelines. A reduction in unsuitable cases treated after 2009 does not explain the global loss of referrals.
authors.forename: Ramon E
authors.initials: RE
authors.lastname: Jimenez
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hollander
authors.forename: Timothy
authors.initials: T
authors.lastname: Boyd
mesh_terms: D001918:Brachytherapy / Q000379:methods / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D003237:Connecticut / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D009367:Neoplasm Staging / Q000379:methods; D059351:Organ Sparing Treatments / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D014600:Utilization Review