More women need breasts removed after brachytherapy
Women who got seed radiation as part of their breast cancer treatment were more likely to have an infection or breast pain than those who were treated with whole-breast irradiation, in a new study.
And more patients treated with the quicker and more local radiation technique, also called brachytherapy, went on to need a mastectomy as well - but there was no difference in their chance of dying in the few years after treatment.
“The decision of whether a patient was treated with brachytherapy or whole-breast irradiation was the single most important factor in whether a patient had a mastectomy,” said study author Dr. Benjamin Smith, who called that result “surprising.”
“It had generally been thought that if it was used carefully in the appropriate patients, the risks of mastectomy or recurrence would be basically the same in patients treated with brachytherapy or whole-breast irradiation,” Smith, from the MD Anderson Cancer Center in Houston, Texas, told Reuters Health.
Brachytherapy involves putting a small device - a balloon or a catheter - into the breast, where it delivers a dose of radiation to kill any extra cancer around the cavity where a tumor was removed.
The technique is frequently used to treat prostate and cervical cancer, but it’s only in the last decade that devices have been available to use in the breast, Smith said.
What is Brachytherapy?
This year, more than 200,000 new cases of breast cancer will be diagnosed in the United States. Surgical removal of the cancer lump (lumpectomy) is usually the first step. After this surgery, women with early breast cancer are offered mastectomy (surgical removal of the entire breast) or radiation therapy to the breast. Most women choose radiation because the survival rate for such treatment is the same as with mastectomy, and it allows the patient to preserve her breast.
Radiation treatments are given to kill off any possible remaining cancer cells in the breast. Radiation is done to help prevent a recurrence, or return, of breast cancer and can be given with external or internal radiation. External beam radiation, also called whole-breast irradiation (WBI), treats the whole breast from the outside, by aiming highly penetrating x-rays at your tumor cavity.
External beam radiation begins four to six weeks after surgery. Patients receive one treatment a day for six to seven weeks. It is very successful in preventing recurrence of cancer in the breast, but many women find the long duration of treatment to be burdensome.
The advantages over whole-breast irradiation - the other option for women who want to keep their breasts - is that less tissue gets hit with radiation. And brachytherapy only takes five days to complete, compared to six or seven weeks for whole-breast irradiation.
“It’s really nice for women who work outside the home or women who live in rural areas because they can get it done much more quickly,” said Dr. Todd Tuttle, a cancer surgeon from the University of Minnesota in Minneapolis.
“It’s become very popular in the United States, without a lot of good data so far,” said Tuttle, who wasn’t part of the research team.
Breast Brachytherapy ( High Dose Rate Brachytherapy for Breast Cancer )
Increasingly, women are deciding to have treatment of breast cancer with a safe and effective form of radiation therapy known as “breast brachytherapy”. This method of therapy, which delivers radiation directly into a tumor site from the inside out, is a way to save most of the normal breast tissue, preserve the cosmetic appearance of the breast, and avoid the physical and emotional trauma of extensive breast removal surgery.
In the past, radiation has been administered to a patient’s “entire” breast (whole breast radiation) via external beam radiation therapy (EBRT). EBRT treatment is delivered to the tumor site via a radioactive beam from outside the patient’s body on a daily basis over an approximate 7 week time period. Recent studies have however shown that in most cases, limiting radiation to just “part” of the breast (partial breast radiation) is equally as effective and causes less injury to surrounding healthy breast tissue.
While both external beam and brachytherapy can be utilized to deliver partial breast radiation, brachytherapy is the quickest, most direct, and conformal way to deliver the radiation to the target.
For the new study, Smith and his colleagues analyzed Medicare insurance claims for close to 93,000 older women with cancer who got breast-conserving surgery followed by radiation in 2003 through 2007. About 7,000 of them were treated with brachytherapy, and the rest with whole-breast irradiation.
Over the next five years, four percent of women who’d had brachytherapy got their breasts removed because of a cancer recurrence or for another reason. That compared to about two percent of those who got whole-breast irradiation and needed a mastectomy.
The Advantages of High dose rate Brachytherapy
- Overall treatment time is 1 week versus 6 to 7 weeks for external beam radiation therapy.
- Conserve your breast and yield excellent cosmetic results.
- Breast brachytherapy delivers a precisely targeted dose to the tissues most at risk for recurrence, increasing the likelihood of tumor control.
- Reduces radiation dose to the lungs and opposite breast.
- Avoids potential long term side effects by reducing radiation doses to healthy tissue.
- Breast brachytherapy causes no delays in other treatments such as chemotherapy.
- Placement of the applicator (Tube and Button or Mammosite balloon) is simple and safe.
- Treatment is given on an outpatient basis, so no hospital stay is required.
Patients treated with brachytherapy were also more likely to get an infection over the next year, or to have breast pain or fracture a rib during study follow-up, the researchers reported in the Journal of the American Medical Association.
They calculated that 56 women would have to get brachytherapy instead of whole-breast irradiation for one to need a mastectomy. And between nine and 16 patients would need to get the local treatment for one extra woman to have a complication, such as an infection.