Brachytherapy is tied to more wound and skin complications than the standard radiation technique, according to the results of a study published in the Journal of Clinical Oncology.
For women with early-stage breast cancer who are treated with breast-conserving surgery (lumpectomy), surgery is generally followed by radiation therapy in order to reduce the risk of cancer recurrence. Radiation therapy is often delivered to the whole breast from a machine outside the body (external beam radiation therapy). This treatment is commonly delivered on a daily basis for several weeks.
Breast brachytherapy is a potential alternative to traditional external beam radiation therapy for women who choose breast-conserving surgery, but randomized trials comparing the two treatments are still pending. While many physicians only offer this approach as part of a clinical trial, others have used it more routinely. During brachytherapy, a specialized catheter that contains radioactive material is placed directly into the area of the breast where the cancer was removed. This is often done twice daily over a period of a week or so. Because this approach requires many fewer weeks of treatment than conventional external beam radiation therapy, it may be a much more convenient option for the patient—however, information about the safety and efficacy of breast brachytherapy is somewhat limited.
In this study, researchers compared overall, wound and skin, and deep-tissue and bone complications between brachytherapy and whole-breast irradiation (WBI) at one year of follow-up. The study included nearly 30,000 Medicare beneficiaries ages 66 to 94 years who underwent breast-conserving surgery in 2008 or 2009 and were subsequently treated with brachytherapy or WBI.
The results indicated that 16 percent of patients underwent brachytherapy, although the rates varied widely across different regions—in some areas no women underwent brachytherapy and in others 70 percent did. After accounting for patient characteristics such as income, overall health, and whether or not they had chemotherapy, the researchers found that 35 percent of women who underwent brachytherapy experienced complications, compared with only 18 percent of women who underwent WBI. Complications included infections or other issues related to the wound or skin.
The researchers concluded that after one year, wound and skin complications were significantly higher among women receiving brachytherapy compared with those receiving WBI—in fact, the data indicated that brachytherapy was associated with a 16.9 percent higher rate of wound and skin complications than WBI.
Women who may need radiation after breast-conserving surgery are advised to discuss the risks and benefits of the different radiation techniques with their physician.
Presley CJ, Soulos PR, Herrin J, et al. Patterns of use and short-term complications of breast brachytherapy in the national Medicare population from 2008-2009. Journal of Clinical Oncology. Published early online October 22, 2012. doi: 10.1200/JCO.2012.43.5297
Posted October 29, 2012
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