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Patterns indicated great variation in use of accelerated partial breast irradiation with brachytherapy
Hattangadi JA. J Natl Cancer Inst. 2011;104:1-13.
The use of accelerated partial breast irradiation with brachytherapy after breast-conserving surgery is increasing among patients in the United States; however, data from a recently published study indicate that not all patients undergoing this treatment are suitable for it.
In the study, researchers used data from the SEER registry to identify 138,815 women with diagnosed breast cancer between 2000 and 2007. All women had undergone either whole-breast irradiation or accelerated partial-breast irradiation using brachytherapy (APBIb) after breast-conserving surgery. The researchers then examined patient characteristics to classify the women as suitable, cautionary or unsuitable for treatment with APBIb based upon the guidelines released in 2009 by the American Society for Radiation Oncology.
Between 2000 and 2007, the use of APBIb increased form 0.4% to 6.6%. Among those women considered to be suitable for the treatment, it increased from 0.7% to 11%. Of the total cohort, only 3,576 patients (2.6%) underwent APBIb. However, of them, 65.8% of patients were classified as cautionary or unsuitable for treatment with APBIb (see chart).
Usage patterns for APBIb varied greatly. For example, among those patients classified as cautionary or unsuitable, white women were more likely to get treatment with APBIb, as were women who lived in urban areas compared with rural areas.
In an accompanying editorial, Simona F. Shaitelman, MD, assistant professor in the department of radiation oncology at The University of Texas MD Anderson Cancer Center, said it was reassuring that the researchers found the fastest increase in utilization among patients classified as "suitable," even if the majority of patients undergoing APBIb in their study were not classified as suitable.
Shaitelman also commented on the researchers' suggestion that financial interests might be driving usage, and she noted that reimbursement was decreased for the procedure after the end of the period of the study.
"Moving forward, it will be useful to analyze more recent trends in the use of APBI and to document whether such changes in financial remuneration are indeed associated with the delivery of APBI," she wrote.
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