This article is more than 5 years old. Information may no longer be current.
Brachytherapy led to more complications in older breast cancer patients
Click Here to Manage Email Alerts
Older patients with breast cancer receiving brachytherapy had significantly higher wound and skin complications compared with patients receiving whole-breast irradiation after a 1-year follow-up, according to recent study data.
Brachytherapy is considered an alternative to the standard whole-breast irradiation (WBI) for early stage breast cancer. Although highly regarded for its low complication rates, clinical practice treatment patterns for brachytherapy remain unknown, according to background information in the study.
“This treatment method seems ideal in theory, but we found it concerning that such an important clinical decision that affects so many women was being on the basis of theory, rather than scientific evidence,” Cary P. Gross, MD, associate professor in the department of internal medicine at Yale University School of Medicine, said in a press release “Despite the absence of large randomized controlled trials comparing these two treatments, brachytherapy has become increasingly popular, in part because a theoretically lower rate of complications.”
For the study, Carolyn J. Presley, MD, research fellow in the department of internal medicine at Yale University School of Medicine, and colleagues compared wound and skin, and deep-tissue and bone complications between brachytherapy and WBI at 1-year follow-up.
Researchers constructed a national sample of Medicare beneficiaries aged 66 to 94 years who underwent breast-conserving surgery from 2008 to 2009 and were treated with brachytherapy or WBI. Researchers used hospital referral regions (HRRs) to examine national treatment variations.
Presley and colleagues assembled an instrumental variable analysis to compare complication rates between treatment groups, adjusting for patient characteristics, according to the study results.
Presley and colleagues enrolled 29,648 patients for the study, of whom 4,671 (15.8%) received brachytherapy.
The percent of patients receiving brachytherapy varied substantially among HRRs, ranging from less than 5% of patients in some areas to more than 70% in others, according to the study findings.
Of the women treated with brachytherapy, 34.3% had a complication vs. 27.3% of women treated with WBI (P<.001). After adjusting for patient and clinical characteristics, 35.2% of women treated with brachytherapy (95% CI, 28.6-41.9) had a complication vs. 18.4% treated with WBI (95% CI, 15.5-21.3).
Brachytherapy was associated with 16.9% higher rate of wound and skin complications compared with WBI (95% CI, 10-23.9), results of the study indicated.
Researchers did not find a difference between deep-tissue and bone complications.
“This study highlights the importance of conducting comparative effectiveness research before a new treatment becomes widespread,” Gross concluded in a press release. “Medicare is spending significantly more money to cover this treatment, which potentially exposes women to a higher risk of complications than the ‘tried and true’ whole-breast irradiation.’”
Disclosure: Presley reports no relevant financial disclosures. Other researchers in the study reported consulting roles and grant work for Fair Health and Medtronic.
Click Here to Manage Email Alerts