Rapid increase in brachytherapy for breast cancer, but is this wise?

“The most plausible explanation for our data is that women treated with brachytherapy were at increased risk of having a recurrence of cancer in their breast”

A large federally funded study is trying to clarify the risks and benefits of brachytherapy for breast cancer. But the results won’t be out for years.

includes audio. Wider Use Of Breast Cancer Radiation Technique Raises Concern http://www.npr.org/blogs health/2012/04/09/150088892/wider-use-of-breast-cancer-radiation-technique-raises-concern?ps=sh_stcathdl “…..there’s an intense debate under way about whether the approach is being used too widely before there’s clear evidence it’s as effective as the traditional approach.

“I see the rush to brachytherapy is somewhat inappropriate because it has not yet been proven in a randomized trial to be as effective as a standard treatment,” says Bhadrasain Vikram of the National Cancer Institute……
To get ready for brachytherapy, a surgeon temporarily implants a small
device called a catheter in the spot where the tumor was removed. The
device houses a bundle of tiny, flexible tubes that protrude from the
side of the breast.

For each treatment, a technician connects each of the tubes from the
implant to a radiation machine. That allows the doctor to deliver high
doses of radiation to specific spots inside the breast.

The radiation comes from a tiny pellet that’s at the end of a very
thin wire. One by one, the radiation-tipped wire snakes in and out of
each tube in the implant. Patients get treated twice a day for 10
days. Each session takes a few minutes.

In recent years, the popularity of the therapy has soared, rising from
less than 1 percent of patients in 2001 to 10 percent in 2006, Vikram
says.

“It was a tenfold increase over a five-year period,” he says.

Vikram worries that there’s not enough proof yet that brachytherapy is
as effective as what doctors have been using for years. And, he notes,
there are some big concerns: “that the tumor will recur and women will
need more mastectomies, and/or the tumor may spread to other parts of
the body and kill the woman, or it may have more toxicity in the long
term.”

Those fears spiked in December when Benjamin Smith of the M.D.
Anderson Cancer Center in Texas unveiled the results of a big study at
a scientific meeting in San Antonio.

“We found that the decision of whether or not a patient was treated
with brachytherapy or whole breast irradiation was the single most
important predictor of whether they had a mastectomy within five years
of their cancer diagnosis,” Smith says.
Mastectomies were rare no matter what kind of radiation women got. But
they were about twice as common among the women who got brachytherapy,
Smith and his colleagues found. That’s a red flag that brachytherapy
might not be snuffing out the cancer as well, Smith says.

“The most plausible explanation for our data is that women treated with brachytherapy were at increased risk of having a recurrence of cancer in their breast,” he says.
Smith and his colleagues also found that women getting brachytherapy
were more likely to experience minor complications, such as infections
and bleeding.

“When you put together significantly increased risk of a lot of
different complications and a treatment that’s slightly less effective
potentially than whole breast irradiation, then you start to wonder,
‘What is the role of this treatment? And have we adopted it too
quickly before we really understand how to use it correctly?’ ” Smith
says.

He and Vikram say women should get brachytherapy for breast cancer
only as part of carefully designed studies…… A large federally funded study is trying to clarify the risks and benefits of brachytherapy for breast cancer. But the results won’t be out for years.