Taghian Alphonse, Jagsi Reshma, Makris Andreas, Goldberg Saveli, Ceilley Elizabeth, Grignon Laurent, Powell Simon
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA 02114, USA.
Int J Radiat Oncol Biol Phys. 2004 Nov 1;60(3):706-14. doi: 10.1016/j.ijrobp.2004.04.027.
To examine the self-reported practice patterns of radiation oncologists in North America and Europe regarding radiotherapy to the internal mammary lymph node chain (IMC) in breast cancer patients.
A survey questionnaire was sent in 2001 to physician members of the American Society for Therapeutic Radiology and Oncology and European Society for Therapeutic Radiology and Oncology regarding their management of breast cancer. Respondents were asked whether they would treat the IMC in several clinical scenarios.
A total of 435 responses were obtained from European and 702 responses from North American radiation oncologists. Respondents were increasingly likely to report IMC irradiation in scenarios with greater axillary involvement. Responses varied widely among different European regions, the United States, and Canada (p < 0.01). European respondents were more likely to treat the IMC (p < 0.01) than their North American counterparts. Academic physicians were more likely to treat the IMC than those in nonacademic positions (p < 0.01).
The results of this study revealed significant international variation in attitudes regarding treatment of the IMC. The international patterns of variation mirror the divergent conclusions of studies conducted in the different regions, indicating that physicians may rely preferentially on evidence from local studies when making difficult treatment decisions. These variations in self-reported practice patterns indicate the need for greater data in this area, particularly from international cooperative trials. The cultural predispositions documented in this study are important to recognize, because they may continue to affect physician attitudes and practices, even as greater evidence accumulates.
研究北美和欧洲放射肿瘤学家针对乳腺癌患者内乳淋巴结链（IMC）进行放射治疗的自我报告实践模式。
2001年向美国放射肿瘤治疗学会和欧洲放射肿瘤治疗学会的医师会员发送了一份关于乳腺癌治疗管理的调查问卷。询问受访者在几种临床情况下是否会对内乳淋巴结链进行治疗。
欧洲放射肿瘤学家共收到435份回复，北美放射肿瘤学家收到702份回复。在腋窝受累程度较高的情况下，受访者越来越倾向于报告对内乳淋巴结链进行照射。不同欧洲地区、美国和加拿大之间的回复差异很大（p < 0.01）。欧洲受访者比北美受访者更有可能对内乳淋巴结链进行治疗（p < 0.01）。学术医师比非学术职位的医师更有可能对内乳淋巴结链进行治疗（p < 0.01）。
本研究结果显示，在对内乳淋巴结链治疗的态度上存在显著的国际差异。国际差异模式反映了不同地区研究得出的不同结论，表明医生在做出艰难的治疗决策时可能优先依赖本地研究的证据。自我报告的实践模式中的这些差异表明，该领域需要更多数据，特别是来自国际合作试验的数据。本研究记录的文化倾向很重要，因为即使积累了更多证据，它们可能仍会影响医生的态度和实践。
