Hyped by Radiation Oncologists and hospital administrators for the last ten years, brachytherapy for breast cancer seemed attractive. What is brachytherapy? After lumpectomy a radioactive probe is inserted into the cavity left by removal of the lump and left there for several days. That is all the radiation the woman gets. No daily trips for five or six weeks; none of the usual sunburn, lung damage or skin change. The fees associated with this new procedure are huge compared to the effort expended. Surgeons and Radiation Oncologists have accepted this new approach uncritically and enthusiastically. When the radiation facility purchases the equipment necessary to do this the marketing follows. So what about long-term results? Some early studies suggested that the results are equivalent to those achieved with conventional external-beam five-week radiation. Now the International Journal of Radiation Oncology Biology and Physics reports on a huge study in which Medicare claims data are mined to find thousands of women who were diagnosed with localized breast cancer and treated with the two types of radiation. Contact Dr. Stark for a copy of the article. He cannot create a link to it because of copyright issues. Since these women were in the Medicare database they were all older than 65. The results of brachytherapy are clearly inferior to external beam. The salvage mastectomy rate (for those women whose cancers were not eradicated by radiation) was double for those women who received brachytherapy. The overall numbers were low, with fewer than 5% of women who received brachytherapy requiring mastectomy. However, the average follow up was quite short (5 years or less) and the group as a whole should have enjoyed a very favorable prognosis based on how the patients were selected for analysis. How do these data extrapolate for women in general, where the average age of women with breast cancer is 52? Dr. Stark weighs in: “The results of this study are worrisome; younger women have more aggressive cancers and many Radiation Oncologists treat patients in a risk group higher than what was analyzed in this study. I never recommended this procedure for women given the long history or the safety of external beam. This study justifies my cautious approach.”
Update 2020: long term results are now becoming available. Partial breast irradiation is slightly inferior to whole breast irradiation — not different enough to reach statistical significance but worrisom. Click here for the abstract. Dr. Stark can provide the entire article. The final results of this trial are still pending. Stay tuned.