Radiation therapy commonly is used after lumpectomy to treat early-stage breast cancer and reduce the risk of the cancer coming back (recurrence). Brachytherapy is a newer form of radiation therapy and an alternative to external beam radiation therapy.
Brachytherapy delivers a higher dose of radiation to a smaller area of the breast over a shorter period of time than traditional (external beam) radiation therapy. The study reviewed here found that brachytherapy use has been increasing steadily since it was first approved by the U.S. Food and Drug Administration in 2002. The researchers are concerned about this increase in brachytherapy use because there aren't many long-term studies that show that brachytherapy works as well as traditional radiation therapy.
Traditional external beam radiation therapy aims cancer-destroying energy at the whole breast or to the area of the breast where the cancer was. The source of the radiation is outside the breast, which is why it's called "external beam." Many studies have shown the long- and short-term effectiveness of external beam radiation therapy. The drawbacks of traditional radiation therapy include daily trips to the hospital for treatments -- typically 5 days a week for 4 to 6 weeks. Traditional radiation therapy also has a large field and may expose healthy tissue, such as the heart and lungs, to radiation.
To overcome the drawbacks of traditional radiation therapy, doctors have developed different ways to deliver radiation. Brachytherapy places the radiation source inside the breast. Two types of brachytherapy are used right now:
In this study, researchers looked at the medical records of nearly 7,000 women age 65 or older who were diagnosed with breast cancer between 2001 and 2006. Almost all of the women were diagnosed with early-stage breast cancer, although a few of the women were diagnosed with metastatic breast cancer. All of the women had lumpectomy followed by some type of radiation therapy:
Even though overall only 5% of all the women had brachytherapy, as time went on, more women chose brachytherapy. Looking at the women's radiation choices by year:
Several medical and non-medical factors seem to be linked to a woman choosing brachytherapy over external beam radiation therapy, including:
Even though brachytherapy is becoming a more popular radiation therapy choice, the researchers pointed out that right now there's limited evidence that brachytherapy is effective over a long period of time. Still, brachytherapy's safety and effectiveness are being studied and the results so far have been reassuring. Besides being a quicker way to deliver radiation therapy, many doctors like brachytherapy because the radiation is delivered in a focused manner, potentially avoiding exposing healthy tissue to radiation.
If you'll be receiving radiation therapy after lumpectomy, you and your doctor may consider brachytherapy as an alternative to traditional external beam radiation therapy. Perhaps the daily trips to the treatment center would be a burden because of distance. Talk to your doctors about their experience with brachytherapy compared to traditional radiation therapy. You also may want to ask about their familiarity with the technical aspects of delivering brachytherapy since placement of the catheters or balloon is a skill that can take some time to master.
The Breastcancer.org Radiation Therapy section has more information on both traditional external beam radiation therapy and brachytherapy.
CHICAGO (MedPage Today) -- Use of brachytherapy to treat breast cancer continues to increase despite unresolved questions about long-term outcomes, according to data presented here.
From 2001 through 2006, breast brachytherapy accounted for 5% of all radiation therapy administered to a cohort of more than 6,000 postmenopausal breast cancer patients. However, in the years after 2004 -- when Medicare began reimbursing for the modality -- use of the modality more than doubled, to 10% in the first half of 2006.
The findings strongly suggest that nonclinical factors will determine breast brachytherapy's role in coming years.
"Despite ongoing debate over long-term outcomes, breast brachytherapy has been rapidly incorporated into treatment of breast cancer," Thomas A. Bushnell's, MD, of the University of Texas M. D. Anderson Cancer Center in Houston, said here at the American Society for Radiation Oncology meeting.
"The availability of clinical evidence is less likely to be a major force in determining the diffusion of this new technology. Instead, nonclinical factors -- such as public policy and socioeconomic factors -- are likely to play an important role."
The efficacy of whole-breast irradiation after conservative surgery has been demonstrated in Phase III clinical trials involving 60,000 to 100,000 patient-years of follow-up, said Buchholz. In contrast, Phase III data of partial breast irradiation with brachytherapy has yet to mature and comprises about 1,500 patient-years of follow-up.
The lack of supporting data for breast brachytherapy has created controversy regarding use of the radiation modality, he added.
Access to a nationwide database of Medicare beneficiaries with private supplemental insurance provided an opportunity to examine the use of breast brachytherapy and the factors associated with its use.
Buchholz and his colleagues identified 6,882 women ages 65 and older with newly diagnosed breast cancer from 2001 through 2006. The database provided access to information about inpatient, outpatient, and prescription claims.
All of the patients had breast-conserving surgery followed by radiation therapy -- external-beam radiation, brachytherapy, or a combination of the two modalities.
Patients had a mean age of 75, 8% had axillary involvement, and 4% had metastatic disease. Buchholz said that 78% of the cohort had axillary dissection, 10% had chemotherapy, and 65% received endocrine therapy.
Overall, external-beam radiation therapy accounted for 95% of all radiotherapy administered to the patients. Fewer than 1% received both external-beam radiation and brachytherapy, and the remaining patients had brachytherapy as the sole form of radiotherapy.
Trend analysis showed that use of brachytherapy remained stable at about 1% of cases from 2001 to the first half of 2002, when the FDA approved the therapy. Use of brachytherapy increased to about 3% of cases in the second half of 2002 and remained at that level until the first half of 2004, when Medicare started covering brachytherapy.
Brachytherapy continued to account for about 4% of all radiation therapy used to treat breast cancer through 2004, then increased to more than 6% of cases in the first half of 2005, 8% in the second half of 2005, and 10% during the first six months of 2006.
Analysis of clinical factors associated with use of brachytherapy revealed three significant predictors:
Examination of nonclinical factors such as geography, type of healthcare system, income, and availability of radiation oncologists and surgeons all influenced the use of brachytherapy.
Using the northeast region of the U.S. as reference, Buchholz and colleagues found increased use of breast brachytherapy in western states (OR 2.83), in the South (2.36), and in the Midwest (OR 1.62).
Treatment by non-HMO providers also was associated with increased use of brachytherapy (OR 1.81).
A higher median income made use of brachytherapy more likely (OR 1.58), as did a low density of radiation oncologists in an area (1.78) and a high density of surgeons (OR 2.36).
The authors had no disclosures.
Primary source: American Society for Radiation Oncology Source reference: Smith GL, et al "Breast brachytherapy in the U.S.: Utilization patterns in older patienets after breast-conserving surgery" ASTRO 2009; Abstract 164.
Breastcancer.org is a non-profit organization dedicated to providing information and community to those touched by this disease. Learn more about our commitment to providing complete, accurate, and private breast cancer information.
Breastcancer.org 7 East Lancaster Avenue, 3rd Floor Ardmore, PA 19003
©2011 Breastcancer.org - All rights reserved.
