Older Women Have More Complications From Brachytherapy Compared to Whole-Breast Radiation

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Women diagnosed with early-stage breast cancer who have lumpectomy usually have radiation therapy after surgery. Radiation therapy after lumpectomy lowers the risk of breast cancer coming back (recurrence) and makes lumpectomy as effective as mastectomy.

There are two basic ways to deliver radiation. The traditional way is to irradiate the entire breast (whole-breast irradiation) with radiation from an external source. Newer methods deliver radiation internally, or externally in precisely focused three dimensions, to just the area of the breast where the cancer was (partial-breast irradiation). Internal partial-breast irradiation also is called brachytherapy.

A study comparing brachytherapy and whole-breast irradiation after lumpectomy in older women found that women who had brachytherapy were more likely to have complications in the year after treatment compared to women who had whole-breast irradiation.

The study was published online on Oct. 22, 2012 by the Journal of Clinical Oncology. Read the abstract of "Patterns of Use and Short-Term Complications of Breast Brachytherapy in the National Medicare Population From 2008-2009."

Researchers looked at the records of nearly 30,000 women age 66 to 94 with Medicare coverage who were diagnosed with early-stage breast cancer and had lumpectomy followed by brachytherapy or whole-breast irradiation in 2008 or 2009:

  • 4,671 women (15.8%) got brachytherapy
  • almost all the other women had whole-breast irradiation; fewer than 0.5% of the women had both brachytherapy and whole-breast irradiation

Compared to women who got whole-breast irradiation therapy, women who got brachytherapy were more likely to have a wound or skin complication in the year after treatment:

  • 35.2% of women who got brachytherapy had a complication
  • 18.4% of women who got whole-breast irradiation had a complication

There was no difference in deep tissue or bone complications between the two groups.

This study suggests that brachytherapy probably is a worse option than whole-breast irradiation for older women. Research published in May 2012 also found that older women who had brachytherapy were more likely to have treatment complications as well as more likely to need a mastectomy in the 5 years after lumpectomy compared to older women who had whole-breast irradiation.

The drawbacks of traditional whole-breast irradiation include daily trips to the hospital for treatment -- usually 5 days a week for 4 to 6 weeks -- and accidentally exposing nearby healthy tissue (the lungs or the heart, for example) to radiation.

To overcome these drawbacks, doctors developed partial-breast irradiation techniques. The new techniques deliver more focused and intense radiation therapy over a shorter period of time. Because the radiation therapy is more focused, the hope is that the newer techniques will cause fewer or milder side effects than traditional radiation therapy with the same benefit.

Doctors are looking forward to the results of a very large, ongoing study called NSABP B-39/RTOG 0413 that's looking at the effectiveness and safety of three types of partial-breast irradiation and comparing them to whole-breast irradiation in both younger and older women.

The three partial-breast irradiation techniques being studied in the NSABP B-39/RTOG 0413 study are:

  • multi-catheter internal radiation or interstitial needle-catheter brachytherapy (the same type in the study discussed above)
  • balloon internal radiation, known by the brand name MammoSite
  • 3-D conformal external beam radiation (3DCRT)

Brachytherapy uses radioactive "seeds" to deliver radiation directly to the area where the cancer was. The seeds are placed in very small tubes (catheters) that are stitched into place under the skin. The seeds are left in the tubes for a few hours or a few days. You remain in the hospital during treatment. Once the treatment is completed, the seeds, tubes, and stitches are removed and you go home.

The MammoSite system places a special tube with a balloon on one end in the breast where the cancer was. The tube comes out of the skin through a small hole. The tube and balloon are placed either during lumpectomy or afterward in a surgeon's office. During each treatment, a machine places a radioactive seed into the center of the balloon for 5 to 10 minutes -- just long enough to deliver the required dose of radiation. After the seed is removed, you may leave the treatment center. A total of 10 treatments are usually given over 5 days. That means 2 treatments per day, about 6 hours apart. When the final treatment is done, the balloon and tube are removed through the small hole in the skin.

3DCRT radiation starts with a planning session (simulation). A special MRI or CAT scan of the breast is done and is used to map out small treatment fields for the area at risk. The type and distribution of radiation is designed to maximize the dose to the area that needs to be treated and avoid or minimize radiation to tissue near the area. The radiation is delivered with a linear accelerator, the same machine used in traditional external radiation, twice a day for 1 week.

Until more results are published, partial-breast irradiation should be considered a promising experimental approach that hasn’t yet been shown to have the same benefits as whole-breast irradiation. We hope that the NSABP B-39/RTOG 0413 study will give doctors more information.

If you've been diagnosed with early-stage breast cancer and lumpectomy followed by radiation therapy will be part of your treatment, ask your doctor about the radiation therapy options that make the most sense for your unique situation. You and your doctor will consider a number of factors, including:

  • the characteristics of the cancer (size, location, lymph node involvement)
  • your personal preferences (how important is having a shorter total radiation therapy treatment time?)
  • the experience level of your doctors in giving experimental techniques such as brachytherapy

Together you and your doctor will make the best choice for YOU. Visit the Breastcancer.org Radiation Therapy section to learn more about radiation therapy techniques and possible side effects.

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