S494 I. J. Radiation Oncology d Biology d Physics Volume 75, Number 3, Supplement, 2009

16,370 (86.4%) were whites and 2,569 (13.6%) were African Americans. The proportion of these patients who subsequently un-derwent PMRT was determined. Data collection was performed using the SEER Stat 6.4.4 software (Silver Spring, MD).

Results: From 1992 to 2002, the mean percentage of patients who received PMRT increased from 32.6% to 45.5%. This was re-flected in both ethnic groups, with an increase from 34.1% to 46.1% in whites and from 23.9% to 41.4% in African Americanwomen over this time-span. While African Americans were less likely than whites to receive PMRT, the gap had steadily decreasedover this ten-year period.

Conclusions: PMRT use increased significantly between 1992 and 2002 for women with high-risk breast cancer. The observationthat over 50% of patients still do not receive PMRT reflects the controversy surrounding this issue. While the gap between Whiteand African American women undergoing PMRT has apparently narrowed in recent years, a notable difference still exists whichmay ultimately impact outcomes.

Author Disclosure: K. Lam, None; S.L. Martinez, None; S. Chen, None; E. Jung, None; L. Do, None; A. Chen, None.

2694 Use of Supplemental External Beam Radiotherapy in Men with Low-risk Prostate Cancer undergoing

Brachytherapy

A. K. Cheung1, M. Chen2, B. J. Moran3, M. H. Braccioforte3, D. E. Dosoretz4, S. Salenius4, M. Katin4, R. Ross4, A. V. D’Amico1

1Brigham and Women’s Hospital and Dana Farber Cancer Institute, Boston, MA, 2University of Connecticut, Storrs, CT,3Prostate Cancer Foundation of Chicago, Westmont, IL, 421st Century Oncology, Fort Myers, FL

Purpose/Objective(s): Combining external beam radiotherapy (EBRT) with prostate brachytherapy (PB) results in increased tox-icity without proof of improved efficacy compared to PB alone. We investigated the patterns of care for men with low-risk prostatecancer (PC) treated with PB.

Materials/Methods: Our study cohort consisted of 4943 men (median age 69.0) with low-risk PC treated with PB with or withoutsupplemental EBRT from 1991 to 2007 at 1 of 21 centers located in Florida, New York, North Carolina, or Chicago. Multivariablelogistic regression analysis was performed to determine if there was a significant association between the year of PB, PSA level,clinical tumor (T) category, age, and a history of coronary artery disease (h/o CAD) and the use of supplemental EBRT.

Results: Supplemental EBRT was used in 647 men (13%). EBRT use was associated with earlier year of PB (adjusted odds ratio(AOR) 0.94; 95% CI, 0.92–0.97; p\0.001). Between the years 1999–2001, 20.2% received EBRT, compared to 6.2% of mentreated from 2005–2007. EBRT use was also significantly associated with clinical category T2a disease (AOR 1.42; 95% CI,1.17 to 1.72; p\0.001) and a lower PSA level (AOR 0.95; 95% CI, 0.91 to 0.99; p = 0.024). However, men with T2a as comparedto T1c disease had a significantly lower median PSA level (5.4 vs. 6.1 ng/mL, respectively; p\0.001). While a h/o CAD (AOR2.11; 95% CI, 1.77 to 2.51; p\0.001) was associated with EBRT use, there was a statistically significant decrease in use ofEBRT over the study period in these men (p = 0.016). Specifically, from 1999–2001, 25.2% of men with h/o CAD receivedEBRT compared to 9.5% from 2005–2007.

Conclusions: Palpable disease was significantly associated with supplemental EBRT use in men with low-risk PC. While supple-mental EBRT was also used more often in men with a h/o CAD, its use in these men significantly decreased over the study period.

Author Disclosure: A.K. Cheung, None; M. Chen, None; B.J. Moran, None; M.H. Braccioforte, None; D.E. Dosoretz, None; S.Salenius, None; M. Katin, None; R. Ross, None; A.V. D’Amico, None.

2695 Year-end Evaluation of Radiation Oncology Physicians (YEEROP)

V. M. Gironda1, A. M. Trotti1, C. W. Stevens1, W. Zhu2, E. E. Harris1

1H. Lee Moffitt Cancer Center/University of South Florida, Tampa, FL, 2H. Lee Moffitt Cancer Center, Tampa, FL

Purpose/Objective(s): Treatment changes implemented by the peer review process serve an important platform for quality careand practice improvement in clinical radiation oncology. The aim of this study was to determine changes to physician treatmentplans modified by the peer review process over the course of a year and assess physician performance.

Materials/Methods: This is a retrospective review of peer review documents and patient charts exhibiting subsequent treatmentplan changes recommended through the process from February 1, 2008 – February 27, 2009. Evaluation included 15 radiationoncologists and all potentially curative cases (1324) presented during the first week of treatment at a weekly peer review confer-ence. Minor recommended changes indicate treatment plan and parameters were within agreed limits but minimal changes in pa-rameters were recommended to tumor volume coverage, critical structures, prescription dosing, and intent. Major recommendedchanges to these parameters indicate a change that affected the overall treatment plan of the presented patient as recommended bythe peer group.

Results: The average percentage of plans changed per physician was 4% (95% CI .02–.05). Overall changes were recommended andimplemented for 56 (4%) of 1324 treatment plans; 50 (89 %) of these were minor and 6 (11%) were considered major changes. Majorchanges involved prescription dosing (3) and critical structure coverage (3). All recommendations were agreed upon by the present-ing physician. Changes occurred for radiation therapy (RT) treatment techniques used on 28 (50%), 21 (37%), 4 (7%), and 2 (3%)cases treated with intensity-modulated (IMRT), three-dimensional (3D) conformal, two-dimensional (2D), and electron procedures,respectively. One case was excluded for lack of information. Attendance over 52 weeks was 88.9%, with an average of 9 total at-tendees; 5 senior, 3 junior level faculty and 2 resident physicians. The percent of senior or junior level attendees did not affect thepercentage of recommended changes (OR=1.0, p = 0.3 and OR=0.9, p = 0.4), respectively. The Wilcoxon Rank Sum Test revealedno significant difference between the senior and junior level status for the percent of cases changed per physician (exact p = 0.6).

Conclusions: Treatment plans modified per physician were acceptable as was the magnitude of changes recommended and imple-mented. Major changes that may affect cancer treatment outcomes and complication were averted in 11% of cases. The number ofphysicians and their status level does not affect the credibility of peer review which promotes both immediate and long-term im-provements in patient care by ensuring conformance with regulations, professional guidelines, and established practice patterns.

Author Disclosure: V.M. Gironda, None; A.M. Trotti, None; C.W. Stevens, None; W. Zhu, None; E.E. Harris, None.