Breast Cancer Therapy May Carry Increased Relapse Risk

Brachytherapy has higher risk of mastectomy and other complications

(RxWiki News) Brachytherapy places small radioactive sources into the breast cancer tumor bed to kill off any cells that remain after a lumpectomy. It's faster than standard whole-breast radiation therapy. This method may have some serious drawbacks, though.

Women who were treated with brachytherapy following a lumpectomy had a two-fold increased risk of having to have a mastectomy compared to women who had whole-breast irradiation. These findings were presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium.

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This troubling finding was uncovered by Benjamin D. Smith, M.D., assistant professor in the department of radiation oncology at The University of Texas MD Anderson Cancer Center, and colleagues. The team examined 130,535  Medicare claims of women older than 66 years who were diagnosed with invasive breast cancer between 2000 and 2007.

The patients had undergone breast-conserving surgery (lumpectomy), followed by accelerated partial breast brachytherapy alone vs. whole-breast irradiation. The use of brachytherapy had increased over time, accounting for one percent of patients in 2000 and 13 percent in 2007.

Researchers found four percent of women treated with brachytherapy had a subsequent mastectomy, compared to 2.2 percent of women who had undergone traditional radiotherapy.

The bad news didn't stop there. Dr. Smith says there was also twice the number of postoperative infections and other complications in women who had received brachytherapy.

He added that these women "were also more likely to experience radiation-related side effects, such as breast pain, fat necrosis and rib fracture," he said.

Dr. Smith says he was "shocked" by the findings of this study.

dailyRx spoke with one of our Contributing Experts, Daniel B. Kopans, M.D., professor of radiology at Harvard Medical School. He offers his insights, "Since we have been using MRI to evaluate women with breast cancer, we have found that there are many women who have additional foci (spots) of cancer than we ever suspected in the past. These, apparently, have been treated, successfully, in the past with whole breast irradiation," said Dr. Kopans, who is senior radiologist in the Breast Imaging Division Department of Radiology, Massachusetts General Hospital.

He continued, "When radiation is confined to only part of the breast, it is likely that some of these lesions will not be killed and will recur leading to mastectomies. The effort to reduce the amount of radiation, and the time it takes to deliver it will, no doubt lead to higher rates of recurrence. If women are going to be considered for these types of limited radiation, I would recommend MRI prior to treatment to determine whether or not there are other  unsuspected, foci of cancer," Dr. Kopans said.

It should be noted that research is considered preliminary before it is published in a peer-reviewed journal.

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Review Date: 
December 6, 2011