Whole-breast Tx better than brachytherapy in older women

May 10, 2012

Although use of brachytherapy to treat invasive breast cancer after lumpectomy is increasing, whole-breast irradiation has proven superior in 2 important aspects.

In older women with invasive breast cancer, whole-breast irradiation is superior to brachytherapy in terms of breast preservation and treatment-related complications.

Five-year survival rates are comparable for the 2 therapies.

In older women with invasive breast cancer, brachytherapy results in lower rates of breast preservation and more complications than whole-breast irradiation (WBI), but doesn’t seem to affect survival one way or the other.

The findings, published in JAMA (2012;307[17]:1827-1837), come from a retrospective population-based cohort study involving almost 93,000 women aged 67 years or older with incident invasive breast cancer diagnosed between 2003 and 2007. After lumpectomy, about 7,000 of the women received brachytherapy; almost 86,000 received WBI.

At the end of 5 years, 3.95% (95% CI, 3.19%-4.88%) of the women receiving brachytherapy had undergone a mastectomy versus 2.18% (95% CI, 2.04%-2.33%; P<.001) of the women undergoing WBI.

In addition, compared with the women receiving WBI, the women receiving brachytherapy had a 37% higher rate of infectious postoperative complications, a 45% higher rate of noninfectious postoperative complications, an 18% higher 5-year incidence of breast pain, a 67% higher rate of fat necrosis, and a 20% higher rate of rib fracture. But 5-year overall survival was almost identical at 87.66% for the brachytherapy group and 87.04% for the WBI group.

The authors note that the use of brachytherapy is rapidly increasing, and that it is currently offered routinely off-protocol throughout the US. Although the results await validation in a prospective setting, they believe their study offers “critical interim companion data to awaited randomized results” and may help physicians and women assess the risks and benefits of the various therapeutic options.

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