In 2013, the American Society for Radiation Oncology recommended against the routine use of intensity-modulated radiation therapy (IMRT) in breast cancer patients. We evaluated trends in the use of IMRT before and after the release of the recommendation. Using Surveillance, Epidemiology, and End Results Medicare data, we identified 13 457 breast cancer patients diagnosed between 2012 and 2015 who received breast-conserving surgery and postsurgery, whole-breast, IMRT, or three-dimensional conformal radiotherapy. We find that the use of IMRT decreased by 4.6 (95% confidence interval [CI] = 3.6 to 5.6; two-sided P < .001) percentage points in hospital-based clinics. In freestanding radiotherapy clinics, which had baseline rates of IMRT use that were more than 20 percentage points higher than in hospital-based clinics, use of IMRT declined by 6.1 (95% CI = 3.5 to 8.7; two-sided P < .001) percentage points. Use of IMRT declined following the release of the recommendation, but a large share of patients treated in freestanding clinics continue to receive IMRT.

中文翻译：

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发布明智选择的建议后，对乳腺癌患者进行强度调节的放射治疗。

2013年，美国放射肿瘤学会建议不要在乳腺癌患者中常规使用强度调节放射疗法（IMRT）。我们评估了该建议发布前后IMRT的使用趋势。使用监测，流行病学和最终结果Medicare数据，我们确定了2012年至2015年之间确诊的13457例乳腺癌患者，他们接受了保乳手术和术后，全乳，IMRT或三维适形放疗。我们发现IMRT的使用减少了4.6（95％置信区间[CI] = 3.6至5.6；双面P <.001）的百分比在基于医院的诊所中。在独立放疗诊所中，IMRT的使用率比医院诊所高出20个百分点以上，IMRT的使用率下降了6.1（95％CI = 3.5至8.7；双面P  <.001）个百分点。该建议发布后，对IMRT的使用有所下降，但是在独立诊所接受治疗的患者中仍有很大一部分继续接受IMRT。