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POST MASTECTOMY RADIATION SURVEY
Abbreviations:
RT = Radiation Therapy
IMRT = Intensity Modulated RT
PMRT = Post-Mastectomy RT
TEM = Tissue Equivalent Material
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1.
Please indicate where do you work
(Obbligatorio)
Albania
Armenia
Belarus
Belgium
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Finland
France
Georgia
Germany
Greece
Hungary
Israel
Ireland
Italy
Latvia
Lithuania
Macedonia
Moldova
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
Russia
Slovakia
Slovenia
Spain
Switzerland
Sweden
Turkey
Ukraine
United Kingdom
Other (please specify in the field below):
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2.
Please indicate the type of your institution/hospital/department:
(Obbligatorio)
University institution/hospital/department
Satellite institution/hospital/department, university affiliated
Community institution/hospital/department, not university affiliated
Private institution/hospital/department, not university affiliated
Other (please specify in the field below):
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3.
How many years have you been practicing as a radiation oncologist?
(Obbligatorio)
Less than 5 years
Between 5 to 10 years
Between 10 to 20 years
More than 20 years
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4.
In candidates for mastectomy and possible immediate or delayed reconstruction, is the radiation oncologist in your institution consulted on the timing and type of reconstructive surgery?
(Obbligatorio)
Yes, in most cases
Rarely
No, patients are presented only after surgery
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5.
In your opinion who most often influences reconstruction timing (immediate vs delayed)?
(Obbligatorio)
The surgeon
The patient
The radiation oncologist
The medical oncologist
Other (please specify in the field below):
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6.
As a radiation oncologist, are the target volumes after immediate reconstruction well enough defined to apply consistently in daily practice?
(Obbligatorio)
Yes
No
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7.
When planning PMRT, how often do you find target volume(s) and breast shape after immediate reconstruction create difficulties in achieving adequate coverage, whilst respecting dose constraints to organs at risk?
(Obbligatorio)
Never
Less than 30% of the cases
About 30-50% of the cases
More than 50% of the cases
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8.
Which sequence do you generally recommend/prefer for mastectomy candidates? More than 1 answer is possible: select the ones that are most used in your department on a case-by-case basis.
(Obbligatorio)
Mastectomy > RT > Delayed reconstruction (autologous)
Mastectomy > RT > Delayed reconstruction (prosthesis)
Mastectomy > Immediate expander > RT > Definitive reconstruction (prosthesis)
Mastectomy > Immediate autologous reconstruction > RT
Mastectomy > Immediate reconstruction (prosthesis) > RT
Mastectomy > Immediate expander > Chemotherapy > Definitive reconstruction (prosthesis) > RT
RT > Mastectomy and reconstruction (autologous)
RT > Mastectomy and reconstruction (prosthesis)
Varies significantly between cases (and/or treating physicians)
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9.
Which sequence does your Institution perform most often for mastectomy candidates? More than 1 answer is possible: select the ones that are most used in your department on a case-by-case basis.
(Obbligatorio)
Mastectomy > RT > Delayed reconstruction (autologous)
Mastectomy > RT > Delayed reconstruction (prosthesis)
Mastectomy > Immediate expander > RT > Definitive reconstruction (prosthesis)
Mastectomy > Immediate autologous reconstruction > RT
Mastectomy > Immediate reconstruction (prosthesis) > RT
Mastectomy > Immediate expander > Chemotherapy > Definitive reconstruction (prosthesis) > RT
RT > Mastectomy and reconstruction (autologous)
RT > Mastectomy and reconstruction (prosthesis)
Varies significantly between cases (and/or treating physicians)
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10.
For chest wall irradiation (mastectomy without immediate reconstruction), which of the following is an indication for boost at your institution?
(Obbligatorio)
All/most patients are planned for scar boost (and other high risk regions)
Cases with high risk features such as T3-T4, lymphovascular involvement, close/involved margins
Only high risk regions in T4 tumours,
A boost is indicated only for close and/or involved margins
Do not boost
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11.
Following the question before, does an immediate reconstruction change the indication for delivering a boost?
(Obbligatorio)
No. I keep the same indication
Yes. I boost only the patients at the highest risk, e.g. cases of unexpectedly involved margins and/or very small boost volume
Yes. I do not boost after reconstruction
No. I never boost
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12.
Do you use IMRT after immediate reconstruction?
(Obbligatorio)
NB: IMRT includes volumetric/helical IMRT and hybrid techniques combining 3D with IMRT.
Yes, as in many of my patients
without
immediate reconstruction
Yes, in nearly all cases., i.e. much more than in patients
without
reconstruction
Yes, but only when the reconstructed breast and regional lymph nodes (
without
the internal mammary nodes) need irradiation
Yes but only when the reconstructed breast and the regional lymph nodes (
with
the internal mammary nodes) need irradiation
Yes but rarely – only for complex volumes/geometry or when the 3D plan does not meet the dose constraints
No. IMRT is never used and/or is not available for these indications in my institution
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13.
When the expander contains metal ports, do you use specific algorithms for the metal material and/or higher photon energies for dosimetry?
(Obbligatorio)
Yes
No
Not applicable – surgeons never use expanders containing metal ports as they know they affect dosimetry
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14.
Does your Institution use TEM after mastectomy
without
immediate reconstruction?
(Obbligatorio)
Yes. Bolus to the entire chest wall
Yes. Bolus to the scar only
No, unless skin is involved
Never, even if skin is involved
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15.
Does your Institution use TEM after mastectomy
with
immediate reconstruction?
(Obbligatorio)
Yes. Bolus to the entire chest wall
Yes. Bolus to the scar only
No, unless skin is involved
Never, even if skin is involved
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16.
Which bolus/TEM schedule do you use after mastectomy
with
or
without
immediate reconstruction?
(Obbligatorio)
Daily for entire treatment
Alternate days for entire treatment
Daily for the first half of treatment (e.g. first 12-13 days out of 25 )
Varies from patient to patient, depending on the treatment plan
Varies from patient to patient, depending on the acute skin reaction
Other schedule. Please specify
Not applicable
Other schedules (please specify in the field below):
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17.
Which bolus/TEM thickness do you use (for 6 MV)?
(Obbligatorio)
3 mm
5 mm
10 mm
15 mm
Varies with cases
Not applicable
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18.
Assuming an indication exists for PMRT, which radiation do you use to boost the skin/nipple, after skin sparing or nipple sparing mastectomy?
(Obbligatorio)
No boost, unless special indications (like involved margins or skin involvement)
Boost via electrons
Boost via photons
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19.
Excluding the boost dose, which schedule does your Institution use for PMRT without reconstruction?
(Obbligatorio)
Traditional fractionation (1.8–2.1Gy per fraction, over 25–28 fractions)
Hypo-fractionation (2.5–3.0 Gy per fraction / over 13–16 fractions)
Accelerated, b.i.d. fractionation ( 1.5 Gy per fraction to a dose of > 45 Gy)
Two of the above fractionations schedules, depending on the case
All of the above fractionations schemes, depending on the case
Other schedules (please specify in the field below):
*
20.
Excluding the boost dose, which schedule does your Institution use for PMRT after immediate reconstruction without regional nodal irradiation?
(Obbligatorio)
Traditional fractionation (1.8–2.1Gy per fraction, over 25–28 fractions)
Hypo-fractionation (2.5–3.0 Gy per fraction / over 13–16 fractions)
Accelerated, b.i.d. fractionation ( 1.5 Gy per fraction to a dose of > 45 Gy)
Two of the above fractionations schedules, depending on the case
All of the above fractionations schemes, depending on the case
Other schedules (please specify in the field below):
*
21.
Excluding the boost dose, which schedule does your Institution use for PMRT after immediate reconstruction with regional nodal irradiation?
(Obbligatorio)
Traditional fractionation (1.8–2.1Gy per fraction, over 25–28 fractions)
Hypo-fractionation (2.5–3.0 Gy per fraction / over 13–16 fractions)
Accelerated, b.i.d. fractionation ( 1.5 Gy per fraction to a dose of > 45 Gy)
Two of the above fractionations schedules, depending on the case
All of the above fractionations schemes, depending on the case
Other schedules (please specify in the field below):