Brachytherapy may increase risk of mastectomy

Brachytherapy is associated with increased risk of subsequent mastectomy and more complications compared to whole-breast irradiation (WBI), according to a new study published in the Journal of the American Medical Association. Moreover, it did not improve survival. In recent years, use of breast brachytherapy, or an implanted radioactive source, after lumpectomy for early breast cancer has increased substantially despite a lack of randomized trial data comparing its effectiveness with standard WBI.

Researchers from the University of Texas M.D. Anderson Cancer Center in Houston and the University of Chicago conducted a retrospective cohort study of 92,735 women aged 67 years or older with invasive breast cancer, diagnosed between 2003 and 2007 and followed up through 2008. 6,952 patients treated with brachytherapy were compared to 85,783 with WBI with respect to the likelihood of breast preservation, complications, and five-year overall survival. The researchers found that women treated with brachytherapy were 2.19 times more likely to have subsequent mastectomy compared to women who received WBI. Brachytherapy was associated with more infectious and noninfectious complications, other postoperative complications, subsequent breast pain, fat necrosis, and rib fracture. With all of these additional complications, brachytherapy did not improve five-year overall survival. “For every 56 women treated with breast brachytherapy, 1 woman was harmed with unnecessary mastectomy,” according to the study team.

A prospective clinical trial is underway comparing women who get brachytherapy following lumpectomy and those who receive whole-breast irradiation. The study is still recruiting and results are not expected for several years.

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