Department of Radiation Oncology, Centre hospitalier de l'université de montréal (CHUM), Montréal, Québec, Canada.
Clin Oncol (R Coll Radiol). 2010 Feb;22(1):39-45. doi: 10.1016/j.clon.2009.09.026. Epub 2009 Nov 28.
To document the use of adjuvant regional irradiation after breast-conserving therapy for early stage breast cancer by Canadian radiation oncologists and to identify the factors influencing their clinical decisions.
We conducted a survey to assess the above aims. In April 2008, a questionnaire was sent to 167 members of the Canadian and Quebec Associations of Radiation Oncologists with interest in breast cancer management. The answers were obtained through a dedicated website, which collected the raw data collected for analysis.
In total, 67 radiation oncologists completed the survey, corresponding to a 40% response rate. Most respondents were experienced and high-volume providers. We identified several areas of variation in the decision-making regarding regional lymph node irradiation after breast-conserving therapy. Regarding the decision to combine regional nodal irradiation with irradiation of the breast, the number of positive nodes after axillary dissection (1-3 vs > or =4) was a crucial determinant. For patients with between one and three positive nodes and a nodal ratio of 50%, most respondents added regional irradiation. Similarly, the same nodal ratio of 50% was the main factor for inclusion of the axillary nodal region in the radiation field. However, few radiation oncologists have chosen to include the internal mammary chain in their treatment plan. The number of positive lymph nodes, the nodal ratio, the number of lymph nodes removed and the presence of extracapsular extension were the primary self-reported factors that directed the decision to offer regional radiotherapy.
This survey showed that there is a wide variation of practices among radiation oncologists in Canada. These results support the need for treatment guidelines and provide guidance on which factors should be included in a decision-making algorithm.
记录加拿大放射肿瘤学家在保乳治疗后辅助区域性放疗在早期乳腺癌中的应用，并确定影响其临床决策的因素。
我们进行了一项调查，以评估上述目的。2008 年 4 月，向对乳腺癌管理感兴趣的加拿大和魁北克放射肿瘤学会的 167 名成员发送了一份调查问卷。通过一个专门的网站获得了答案，该网站收集了用于分析的原始数据。
共有 67 名放射肿瘤学家完成了调查，应答率为 40%。大多数受访者经验丰富，且治疗量大。我们发现，在保乳治疗后行区域淋巴结照射的决策方面存在几个方面的差异。关于是否联合区域淋巴结照射与乳房照射，腋窝清扫后阳性淋巴结数量（1-3 个与≥4 个）是一个关键决定因素。对于腋窝清扫后有 1-3 个阳性淋巴结且淋巴结比值为 50%的患者，大多数受访者选择增加区域照射。同样，淋巴结比值为 50%也是纳入腋窝淋巴结区域进行放疗的主要因素。然而，很少有放射肿瘤学家选择将内乳链纳入治疗计划。阳性淋巴结数量、淋巴结比值、淋巴结切除数量以及是否存在包膜外侵犯是决定是否提供区域放疗的主要自我报告因素。
这项调查表明，加拿大的放射肿瘤学家之间存在广泛的实践差异。这些结果支持制定治疗指南的必要性，并为决策算法中应包括哪些因素提供了指导。
