Primary Breast Sarcomas are rare, accounting for less than 1% of breast malignancies. The authors present a case of primary breast liposarcoma in a 58 year old female with a left palpable lump, present since four months. Following core needle biopsy, the nodule was diagnosed as well differentiated liposarcoma. She underwent conservative surgery of the left breast, without radiation therapy. The patient is currently free from any symptoms of local recurrence and metastasis 9 months after surgery.

Purpose/Objective(s): Radiation therapy is a mainstay of treatment for those with cancer. With improved survival of cancer patients, there had been postulation that there would be higher demand for radiation therapy with increasing amounts of patients receiving radiation. Those projections have not appeared to hold true in more recent publications. Recent concerns of the job market have led many to question whether there would be ample patients to meet the influx of graduating radiation oncologists. Additionally, the increased use of hypofractionation was never modeled in previous projections on the demand for radiation therapy. We analyzed available Medicare data to evaluate for trends in supply and demand in the field of Radiation Oncology. Materials/Methods: Medicare Provider Utilization and Payment Data was downloaded from the CMS.gov website for years 2012 − 2018. Radiation Oncology (RO) specific providers from the database and the lines corresponding to the billing code for status checks (77427), were extracted. Status checks were used as a surrogate for length of fractionation with the assumption of five fractions per status check. Filled Radiation Oncology residency positions were taken from The National Residency Matching Program (NRMP) Match results from 2012 − 2019. Results: The overall amount of status checks billed under Medicare in the United States have remained fairly stable from 2012 through 2018. The number of total radiation oncology providers has consistently increased over this same period (27% increase since 2012). The total number of Medicare patients has only increased by 4% since 2012. There has been a steady decline in status checks per provider each year amounting to a 20% decrease in fractions delivered a year per physician in 2018 as compared to 2012. This is likely due to both increasing providers and a decrease in fractions delivered per patient (8% since 2012) with a continued trend of more hypofractionation in all practice settings in the US. Additionally, we continue to see increasing amounts of incoming RO residents each year (171 in 2012 to 196 in 2019). Conclusion:We are seeing inverse trends in RO with less status checks per physician with continued increasing supply of practicing radiation oncologists. With increasing rates of hypofractionation, the initial predictions were that RO providers would be able to treat more patients a year. However, the increased supply of practicing physicians has caused an opposite trend with physicians delivering 20% less treatments a year than 2012. The positive is that the number of total patients has increased since 2012. The transition to the alternative payment model will reduce the impact of hypofractionation on reimbursement though RO physicians under wRVU production-based reimbursement models will benefit less. Further work and research are needed to explore new indications for radiation as well as addressing the continuing increase in the radiation oncology workforce.