It’s Complicated

Brachytherapy in older breast cancer patients causes more complications than whole breast irradiation

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) After breast cancer surgery – particularly lumpectomies – radiation is recommended to kill any lurking cancer cells and reduce the chance the cancer will come back. One method of radiation therapy has complications for some.

Brachytherapy is a type of radiotherapy that uses radioactive “seeds” which are placed in the area left behind by the tumor. It takes days instead of weeks to complete and results in fewer complications – for most women.

For women 65 years and older, though, brachytherapy appears to cause more wound and skin complications than whole breast radiation.

"Discuss the various types of treatment available to you."

Cary P. Gross, MD, associate professor of internal medicine at Yale School of Medicine was the lead author of a recently published study that looked at the records of 30,000 women with Medicare coverage.

“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 made on the basis of theory, rather than scientific evidence,” Dr. Gross said in a press release.

Brachytherapy – which is known as accelerated partial breast irradiation (APBI) – implants radiation “seeds” in the tumor bed following lumpectomy surgery. The procedure takes place about a month after surgery and lasts 8-10 days.

For traditional breast radiotherapy, a specialized machine is used to deliver radiation to the entire breast. This is called external beam radiation. It’s usually given 5 days a week for about 5 weeks.

Researchers in this study discovered elderly women who had brachytherapy had 17 percent more skin and wound complications during the year following the procedure than did women who received whole breast irradiation.

These findings agree with those of a study led by researchers at The University of Texas MD Anderson Cancer Center published earlier this year. Benjamin Smith, MD, assistant professor in MD Anderson's Department of Radiation Oncology, was that study's senior author.

That study found APBI had higher rates of later mastectomy and more radiation-related complications compared to traditional whole breast irradiation in women with early stage breast cancers 

Dr. Gross, who is co-director of the Robert Wood Johnson Clinical Scholars Program at Yale, said “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.”

He told dailyRx News in an email, “Cost was not one of the objectives of this study. In our other ongoing, preliminary work, we are finding that a course of external beam radiation costs Medicare approximately $6,000, with brachytherapy costing about twice that.”

Researchers also found that the use of brachytherapy has been increasing among the Medicare population. Nearly 16 percent of women with Medicare coverage had the procedure in 2008-2009, up from 1 percent in 2000.

Availability of the procedure varied widely across the country, according to the study.

Findings from this research were published in the October issue of the Journal of Clinical Oncology.

The study was funded by a grant from the National Cancer Institute.

Reviewed by: 
Review Date: 
October 31, 2012
Last Updated:
November 5, 2012