Intensity-modulated radiation therapy in breast cancer patients following the release of a choosing wisely recommendation

Abstract

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] ¼ 3.6 to 5.6; two-sided P