title: Trends in the use of implantable accelerated partial breast irradiation for ductal carcinoma in situ: Implications of the recent amendments to the American Society for Radiation Oncology consensus guidelines.
abstract: In 2009, the American Society for Radiation Oncology (ASTRO) published consensus recommendations that stated ductal carcinoma in situ (DCIS) patients were in a "cautionary" group for accelerated partial breast irradiation (APBI) and should not receive APBI outside of a clinical trial. However, very recently, ASTRO placed low-risk DCIS patients in the "suitable" category. Given this recent change, we aimed to use the Surveillance, Epidemiology, and End Results (SEER) database to evaluate past patterns of implantable APBI (IAPBI) utilization in women with DCIS.
  
  
  
  The Surveillance, Epidemiology, and End Results database was queried for patients from 2000 to 2012 with DCIS that underwent lumpectomy and adjuvant radiation therapy. Patients receiving IAPBI were differentiated from those receiving whole breast radiation therapy. Trends based on treatment year and patient demographics were collected, and multivariable logistic regression determined factors independently predictive of use of IAPBI.
  
  
  
  Of 52,012 eligible patients, 49,450 (95%) underwent external beam radiation and 2562 (5%) received APBI. Though IAPBI utilization steadily increased from 2000 (0.2% of the study population) to 2008 (9.4%), it abruptly declined in 2009 (7.9%, p = 0.009) and yearly thereafter. The 40-49 age group was proportionally most associated with this decline (8.6% in 2008 to 4.3% in 2009). Factors independently associated with IAPBI receipt included increasing age, hormone receptor negative status, and women living in the South.
  
  
  
  Patterns of IAPBI administration in DCIS are described. These trends are important to consider as a benchmark going forward, in light of the very recent change in ASTRO recommendations to include low-risk DCIS patients.
authors.affiliation: Department of Radiation Oncology, Greater Houston Physicians Medical Association, Houston, TX. Electronic address: waqarh786@gmail.com.
authors.forename: Waqar
authors.initials: W
authors.lastname: Haque
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Vivek
authors.initials: V
authors.lastname: Verma
authors.affiliation: College of Natural Science and Mathematics, University of Houston, Houston, TX.
authors.forename: Anam
authors.initials: A
authors.lastname: Haque
authors.affiliation: Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX.
authors.forename: E Brian
authors.initials: EB
authors.lastname: Butler
authors.affiliation: Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX.
authors.forename: Bin S
authors.initials: BS
authors.lastname: Teh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000532:radiotherapy* / Q000601:surgery; D032921:Consensus; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant / Q000379:methods / Q000639:trends; D018426:SEER Program; D014481:United States; D055815:Young Adult
keywords: Accelerated partial breast irradiation; Breast cancer; Ductal carcinoma in situ; Radiation therapy