Do radiation oncologists practice evidence based medicine? Results of a survey of management of the axilla in operable breast cancer

In 2002 the Radiation Oncology Expert Advisory Group (ROEAG) of the National Breast Cancer Centre (NBCC) and RANZCR Faculty of Radiation Oncology, posted a questionnaire to practicing radiation oncologists in Australia and New Zealand seeking information on a variety of practical issues in the radiation oncology treatment of women with operable breast cancer. The questionnaire aimed to evaluate the influence of the guidelines and discussion papers published in a resource for radiation oncologists and registrars by the NBCC in the preceding three years. This paper reports on the responses to the questions relating to management of the axilla . A discussion paper containing guidelines on management of the axilla was published in 2001. 102 responses were received (41% response rate) with 93% acknowledging receipt of the paper on management of the axilla. 74% of respondents stated that this paper was important or very important to their practice. Four questions investigating when radiation oncologists would irradiate the entire axilla following an axillary dissection were asked. While 100% of respondents would irradiate the axilla if the surgeon reported unresectable disease in the axilla, 56% of respondents would irradiate the axilla if the pathologist describes extra nodal spread in the report on the operative specimen. The paper 'Management of the Axilla' clearly states that there is no level I or II evidence to support axillary irradiation in patients with' breast cancer based solely on reported extra nodal spread. Factors influencing radiation oncologist's clinical practice will be briefly discussed, as well as the implications for changing practice in response to new clinical trial evidence