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Study finds poorer outcomes with localized, partial-breastapproach. By Carina Storrs HealthDay Reporter TUESDAY, May 1 (HealthDay News) -- Women who receive a type ofpartial-breast radiation called brachytherapy may go on to havehigher rates of breast cancer recurrence and side effects such asbreast pain and infection than women receiving whole-breastradiation, a new study indicates. Brachytherapy is an increasingly popular treatment option for womenwith early-stage breast cancer who have had a lumpectomy, which issurgery to remove just the part of the breast with the tumor. The treatment, which involves inserting a radioactive pellet nearthe lumpectomy site, can be as short as one or two weeks, comparedwith the six-week course of whole-breast radiation, which directsbeams of radiation at the entire breast. In the current study, which was published in the May 2 issue of the Journal of the American Medical Association , researchers looked at the rates of mastectomy (surgical removalof the breast), survival and complications following brachytherapyand whole-breast radiation from national Medicare records of womenaged 67 and older between 2003 and 2007. Although brachytherapy patients experienced more complications andhad more mastectomies, indicating their breast cancer came back,there was no difference in survival rates between the two groupsfive years after treatment. "There is nothing in our study saying that a woman should notchoose brachytherapy if they want the convenience, but I think itis helpful for women to think about the trade-offs, such as higherrates of mastectomy, postoperative complications and infections,"said study author Dr. Benjamin Smith, a radiologist at Universityof Texas M.D. Anderson Cancer Center, in Houston. The study also found that the proportion of women diagnosed withinvasive breast cancer who received brachytherapy increased from3.5 percent in 2003 to 12.5 percent in 2007. This increase isprobably due to a number of factors including patients wanting ashorter treatment course and surgeons driving the choice of theprocedure, which, unlike other forms of radiation therapy, requiressurgery, Smith explained. "The wholesale push to brachytherapy outside of the protocolsetting might be a little overenthusiastic," Smith said. "Our studyreally emphasizes that we need to continue to enroll patients intrials to try to evaluate the technology." Brachytherapy is appropriate for women aged 60 and older with smalltumors that have not spread outside of the breast, along with otherindicators of less-advanced breast cancer, according to a 2009American Society for Radiation Oncology statement written by agroup of doctors that included Smith. In younger women, breast cancer is generally thought to be moreaggressive and data is lacking about the effectiveness ofbrachytherapy in this group, Smith said, adding that his practiceonly offers brachytherapy to younger women as part of clinicaltrials. The current study included nearly 93,000 women aged 67 and older.About 7,000 women received brachytherapy, while almost 86,000 hadwhole-breast radiation. The researchers found that about 4 percent of the women whoreceived brachytherapy had to have a mastectomy within five yearsof their radiation treatment, compared with about 2 percent of thewomen in the whole-breast radiation group. Despite mastectomy rates that were nearly twice as high in thebrachytherapy group, "the overall rate of mastectomy was stillquite low," noted Dr. Sharad Goyal, a radiation oncologist at theUniversity of Medicine & Dentistry of New Jersey. Goyal added that it is not clear from this study whethermastectomies were actually due to breast cancer recurrence orcomplications such as fatty-tissue damage in the breast, which wasmore common in the brachytherapy group. Overall, the rates of infection and other complications were about28 percent among women who received brachytherapy, compared with 17percent of women who received whole-breast radiation. In particular, it is not surprising to see increased rates ofinfection within one year of treatment (16 percent of thebrachytherapy group compared with 10 percent of the whole-breastradiation group) and breast pain within five years of treatment(14.5 percent of the brachytherapy group compared with 12 percentof the whole-breast radiation group), Smith said. Brachytherapy involves "placing a catheter that will be in thepatient's breast for up to two weeks that could allow bacteria toenter the skin and cause an infection," he explained. There was no statistical difference between the five-year survivalrate associated with brachytherapy (87.66 percent) and whole-breastradiation (87.04 percent). Breast cancer survival rates are not asmuch of a concern in this older population as improving the rate ofbreast preservation and decreasing the likelihood of localrecurrence, study author Smith noted. "The study by Smith and his colleagues will not change how Ipractice brachytherapy," Goyal said. "I will inform my patients ofwhat the study found and that there was a higher rate of mastectomywith brachytherapy, but that it is not clear if it was due to tumorrecurrence." For some patients, a greater possibility of having a secondprocedure and a catheter for brachytherapy are enough to make themsteer away from this option, Goyal said. In this case, another form of partial radiation called externalbeam radiation, which is more common than brachytherapy andinvolves an external radiation source directed more locally at thelumpectomy area, can provide similar results as brachytherapy,Goyal added. Brachytherapy might be a more attractive option now than it wasbetween 2003 and 2007, according to Goyal. "I presume that sideeffects will be lower because catheters and imaging modalities haveimproved." However, Smith said he doubts that these improvements will bringmastectomy rates down following brachytherapy because all of thecatheters aim to deliver radiation just to a 1-centimeter ringaround the lumpectomy site. While the current study looked at Medicare records of women who hadalready been treated, "the definitive trials [that follow women]comparing brachytherapy to whole-breast irradiation are stillongoing," but they are years away from giving definitive results,Smith said. More information To learn more about breast cancer treatments, visit the American Cancer Society. SOURCES: Benjamin Smith, M.D., assistant professor, radiationoncology, University of Texas M.D. Anderson Cancer Center, Houston;Sharad Goyal, M.D., assistant professor, radiation oncology, RobertWood Johnson Medical School, University of Medicine & Dentistryof New Jersey, Piscataway, The Cancer Institute of New Jersey, NewBrunswick, N.J.; May 2, 2012, Journal of the American Medical Association Copyright © 2012 HealthDay . All rights reserved. I am an expert from thermometerhygrometerdigital.com, while we provides the quality product, such as China TN LCD panel , Digital Infrared Thermometer, Digital Thermometer Hygrometer,and more.
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