title: Benchmarking clinical practice quality: an audit of ipsilateral breast tumor recurrence in patients managed for T1/T2 breast carcinoma.
abstract: OBJECTIVE
  Breast conserving surgery and adjuvant radiotherapy has equivalent oncological outcomes to mastectomy and is the standard of care for treatment of early-stage invasive breast cancer. Auditing is an essential component of ongoing quality assurance and clinical governance. It also serves to identify patient and tumor factors that have prognostic and therapeutic implications. The aim of this paper is to report on the clinical audit of treatment outcomes for patients undergoing adjuvant radiation treatment for early breast cancer at the Northern Sydney Cancer Care Centre.
  
  
  METHODS
  A total of 1252 patients with T1/2 breast cancer received adjuvant radiation treatment between January 2003 and December 2010. Medical records, including the departmental database, were reviewed to extract pathological, treatment, patient and clinical details.
  
  
  RESULTS
  Median follow-up was 54 months (mean 56.4 months). Sixty-six (5.27%) patients died from breast cancer, and 27 (2.16%) patients died from other disease. Twenty-three (1.84%) patients were alive with metastatic disease, 7 (0.56%) patients were alive following ipsilateral breast tumor recurrence and 7 (0.56%) patients were alive with nodal recurrence. 9 (0.72%) patients were alive with contralateral breast cancer. Documented rates of late toxicity were low: 6.8% of patients had grade 1 late toxicity and 1.6% of patients had grade 2-3 late toxicity.
  
  
  CONCLUSIONS
  Our ipsilateral breast tumor recurrence rate of 0.56% is well within international standards, as is our toxicity rate. We propose that centralized data collection be implemented on a nation-wide level for breast cancer patients undergoing radiotherapy. Further research is planned to identify potential markers of radio-resistance, and allow tailoring of treatment technique to optimize oncological outcome.
authors: Department of Radiation Oncology, Royal North Shore Hospital, Pacific Highway, Australia.
authors: Clare
authors: C
authors: Suttie
authors: Department of Radiation Oncology, Royal North Shore Hospital, Pacific Highway, Australia.
authors: Michael
authors: M
authors: Back
authors: Department of Radiation Oncology, Royal North Shore Hospital, Pacific Highway, Australia.
authors: Jennifer
authors: J
authors: Donovan
authors: Department of Radiation Oncology, Royal North Shore Hospital, Pacific Highway, Australia.
authors: Milan
authors: M
authors: Holecek
authors: Department of Radiation Oncology, Royal North Shore Hospital, Pacific Highway, Australia.
authors: Marita
authors: M
authors: Morgia
authors: Department of Radiation Oncology, Royal North Shore Hospital, Pacific Highway, Australia.
authors: Lesley
authors: L
authors: Guo
authors: Department of Radiation Oncology, Royal North Shore Hospital, Pacific Highway, Australia.
authors: Gillian
authors: G
authors: Lamoury
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008485:Medical Audit; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D016609:Neoplasms, Second Primary / Q000473:pathology*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D016896:Treatment Outcome
keywords: breast; clinical governance; neoplasm recurrence local; radiotherapy; standard of care