Standardization of nodal radiation therapy through changes to a breast cancer clinical pathway throughout a large, integrated cancer center network Brian.

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Standardization of nodal radiation therapy through changes to a breast cancer clinical pathway throughout a large, integrated cancer center network Brian J. Gebhardt, MD, Joel Thomas, BA, Zachary D. Horne, MD, Colin E. Champ, MD, Gretchen M. Ahrendt, MD, Emilia Diego, MD, Dwight E. Heron, MD, MBA, FACRO, FACR, Sushil Beriwal, MD Practical Radiation Oncology Volume 8, Issue 1, Pages 4-12 (January 2018) DOI: 10.1016/j.prro.2017.07.012 Copyright © 2017 American Society for Radiation Oncology Terms and Conditions

Figure 1 An example of the menu-driven clinical support tool user interface. (A) The provider navigates through sequential prompts to select the disease site, stage, and other relevant risk factors. (B) The support tool displays the recommended treatment strategy in an example patient with stage IIA breast cancer who underwent breast-conserving surgery with 1 positive sentinel lymph node without undergoing axillary dissection and had additional adverse factors. Practical Radiation Oncology 2018 8, 4-12DOI: (10.1016/j.prro.2017.07.012) Copyright © 2017 American Society for Radiation Oncology Terms and Conditions

Figure 2 Decision tree depicting clinical pathway treatment recommendations based upon sentinel lymph node biopsy results and clinical risk factors. Practical Radiation Oncology 2018 8, 4-12DOI: (10.1016/j.prro.2017.07.012) Copyright © 2017 American Society for Radiation Oncology Terms and Conditions

Figure 3 Postoperative radiation therapy regional nodal coverage by nodal risk category (A) before modifications to the clinical pathway and (B) following modifications to the clinical pathway.MT, modified tangents; pN1a, macrometastases; pN1mi, micrometastases; SCN, supraclavicular lymph node; WBI, whole breast irradiation. Practical Radiation Oncology 2018 8, 4-12DOI: (10.1016/j.prro.2017.07.012) Copyright © 2017 American Society for Radiation Oncology Terms and Conditions