Brachytherapy Results in More Complications in Older Breast Cancer Patients

Touted for its low complication rates, the breast cancer-treatment brachytherapy actually results in more complications than whole-breast radiation one year after treatment.

Scientists from Yale School of Medicine (New Haven, CT, USA) published their findings in the October 2012 issue of the Journal of Clinical Oncology. The conventional therapy for older women with early stage breast cancer includes breast-conserving surgery, usually followed by radiation therapy to decrease the risk of breast cancer recurrence. Rather than irradiating larger regions of the breast, as in whole breast irradiation, brachytherapy temporarily implants radiation sources in catheters within the surgical site. This technique distributes larger and fewer radiation doses directly to the breast tissue, which results in a condensed treatment time and, and decreased toxicity to neighboring healthy tissue.

“This treatment method seems ideal in theory, but we found it concerning that such an important clinical decision that affects so many women was being made on the basis of theory, rather than scientific evidence,” said the study’s lead author Cary P. Gross, MD, associate professor of internal medicine at Yale School of Medicine. “Despite the absence of large randomized controlled trials comparing these two treatments, brachytherapy has become increasingly popular, in part because of a theoretically lower rate of complications.”

To assess the hypothesis, Dr. Gross and coworkers evaluated a US sample of approximately 30,000 women with Medicare coverage and found that 15.8% of women undergoing radiation therapy received brachytherapy in 2008-2009, up from less than 1% in 2000 and 10% in 2006. There was substantial variation in brachytherapy use across the country, varying from less than 5% of patients in some areas to over 70% in others. The researchers discovered that the use of brachytherapy was associated with a 16.9% higher rate of wound and skin complications in the year after treatment compared to whole breast irradiation. There was no substantial disparity in the rate of bone complications or deep tissue between the two treatments.

“This study highlights the importance of conducting comparative effectiveness research before a new treatment becomes widespread,” concluded Dr. Gross, who is codirector of the Robert Wood Johnson Clinical Scholars Program at Yale. “Medicare is spending significantly more money to cover this treatment, which potentially exposes women to a higher risk of complications than the ‘tried and true’ whole breast irradiation.”

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Yale School of Medicine