More women need breasts removed after brachytherapy
“Many surgeons are starting to think twice about this kind of therapy for a lot of women,” Tuttle told Reuters Health.
“Although it’s very attractive at first because you are potentially treating a lot less of the breast and you’re doing it in a much shorter period of time, the benefits may not be there. In fact you may see more patients having long-term complications,” he said.
Still, Smith said outcomes were generally “very good” across all patients. Five years after their initial surgery, 87 to 88 percent of women were still alive, regardless of what type of radiation they’d received.
Dr. Jona Hattangadi, a radiation oncologist from Brigham and Women’s Hospital in Boston, agreed the risks seemed to be low with both types of radiation.
What is Brachytherapy?
The prefix “brachy” is the Greek word for “short” distance. Brachytherapy is a form of internal radiation treatment where radioactive sources are placed on or into cancer tissues. There are two kinds of brachytherapy. The radiation sources may be inserted either permanently or temporarily. The two most common forms of treatment are low dose rate (LDR) permanent seeds for prostate cancer and high dose rate (HDR) temporary brachytherapy, that can be used for prostate, gynecologic, breast, head and neck, lung, esophageal, bile duct, anorectal, sarcoma, and other cancers.
What is high dose rate (HDR) Brachytherapy?
High dose rate (HDR) is a technically advanced form of brachytherapy. A high intensity radiation source is delivered with millimeter precision under computer guidance directly into the tumor killing it from the inside out while avoiding injury to surrounding normal healthy tissue. For a more in depth explanation please visit the understanding HDR Brachytherapy page.
How does radiation kill cancer?
Cancer is made of abnormal cells that tend to grow without control. Cancer DNA is more sensitive to radiation than are normal cells, so radiation kills cancer directly or when the cells attempt to multiply while normal tissue in the region is able to repair and recover.
She pointed out the limitations of a so-called retrospective study - including that researchers can’t prove the brachytherapy, itself, was to blame for extra complications and mastectomies.
It could be, for example, that the types of women who opt for brachytherapy are more likely to need a mastectomy anyway - such as if they go for longer periods of time without coming in to see their doctor.
The “gold standard” option would be a study that randomly assigned women to get one method of radiation or the other, researchers said. That type of analysis is being conducted now, but results won’t be available for another few years.
“Physicians need to be selective in who they choose to offer (brachytherapy) to,” Hattangadi told Reuters Health. “It may not be uniformly something that should be given to all patients.”
“Some of the trade-offs in convenience, efficacy and complications between whole-breast irradiation and brachytherapy may be more complex than we initially appreciated,” Smith said.
That doesn’t mean women shouldn’t get brachytherapy, especially those who are okay with a slightly increased chance they’ll need their breasts removed.
But because the treatment “can be a little bit risky,” patients should make sure they’re having it done by experienced doctors who will monitor them carefully, Smith added.
And women should be educated about all of their radiation options before going forward with any treatment, according to Hattangadi, who wasn’t involved in the new study.
“It’s important for any woman really to discuss with her physician the risks and benefits of either approach,” she said.
SOURCE: Journal of the American Medical Association, online May 1, 2012.
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