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New Radiation Technique Linked to More Complications in Breast Cancer Patients

Wound and skin complications significantly higher versus standard whole-breast irradiation (Oct. 22)

A new and increasingly popular radiation treatment called brachytherapy is associated with more wound and skin complications than standard whole-breast irradiation, according to an article published in the October 22 issue of the Journal of Clinical Oncology. And yet brachytherapy is commonly used among Medicare beneficiaries, the researchers found.

Typically, the whole breast is irradiated from the outside over several weeks following cancer surgery, but in brachytherapy the radiation is delivered from inside the breast.

The new study looked at a national sample of Medicare beneficiaries aged 66 to 94 years who underwent breast-conserving surgery from 2008 to 2009 and who were treated with brachytherapy or whole-breast irradiation (WBI). The researchers compared overall, wound, skin, deep-tissue, and bone complications between brachytherapy and WBI at 1 year of follow-up.

Of the 29,648 women in the sample, 4,671 (16%) were treated with brachytherapy, although the percent of patients receiving this treatment modality varied substantially across hospital referral regions, ranging from 0% to 71%. After adjusting for patient and clinical characteristics, 35% of women treated with brachytherapy had a complication compared with 18% of those treated with WBI (P < 0.001). Brachytherapy was associated with a 17% higher rate of wound and skin complications compared with WBI (P < 0.001), which translates into approximately 17 additional complications per 100 women treated. There was no difference in deep-tissue and bone complications between the two treatment groups.

An accompanying editorial notes that, in a previous study, brachytherapy was associated with a two-fold increase in subsequent mastectomies, in addition to increased complications, compared with WBI.

Source: Journal of Clinical Oncology, October 22, 2012.

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