FRIDAY, Dec. 16 (HealthDay News) -- The number of women with
breast cancer who receive targeted radiation to the breast after a
lumpectomy has jumped dramatically over the last decade.
However, only about a third of these women were considered
"suitable" for the treatment, according to criteria used in a new
study published in the Dec. 16 online issue of the
Journal of the National Cancer Institute.
But guidelines on which women should or should not receive this
type of radiation treatment, known as brachytherapy, are only newly
published and it's unclear what the findings might mean to current
breast cancer patients.
Use of "accelerated partial breast irradiation using
brachytherapy" has risen steadily since about 2002, said study
author Dr. Jona Hattangadi, a radiation oncologist with Brigham and
Women's Hospital and the Harvard Radiation Oncology Program in
Although brachytherapy is vastly more convenient (taking place
over the course of a week rather than six weeks), the worry is that
directed radiation isn't comprehensive enough to find and kill all
cancer cells lingering in the breast as compared with the current
standard, whole breast radiation (WBI).
So, in 2009, the American Society for Radiation Oncology (ASTRO)
issued the first guidelines for the use of brachytherapy, which
identified patients as either "suitable," "cautionary" (suitability
unclear) or "unsuitable" for the treatment, depending on a number
of factors including age as well as various tumor
These authors rounded up data on 138,815 U.S. women who had been
diagnosed with breast cancer from 2000 to 2007 and who had either
undergone brachytherapy or whole breast irradiation after a
Some 2.6 percent of women underwent brachytherapy, two thirds of
whom were either deemed "cautionary" (29.6 percent) or "unsuitable"
(36.2 percent) according to ASTRO criteria.
Only about a third (32 percent) of patients would have been
considered suitable under ASTRO's recommendations, the study
Use of brachytherapy rose from less than 1 percent in 2000 to
almost 7 percent in 2007, but this varied greatly between
geographical regions, the researchers noted.
For instance, women in urban areas were more likely to get
brachytherapy than women in rural areas, which is surprising given
that rural women would have the most to benefit from the
And white women were more likely to get brachytherapy than black
women if they were considered "cautionary" or "unsuitable."
It's unclear what accounts for the variation or for the rise in
numbers, although the authors did postulate that reimbursement
patterns may play a role. Medicare started reimbursing for
brachytherapy in 2004.
The main drawback of this study, the authors acknowledged, is
that the data was gathered
before the ASTRO guidelines were published.
Dr. Eric Horwitz, M.D., chair of radiation oncology at Fox Chase
Cancer Center in Philadelphia, agreed that brachytherapy is "not
for everybody" but that "it's an excellent technique if used on the
But who is the right patient? Generally people with smaller,
localized tumors, he said.
Still, in the absence of long-term data, Hattangadi recommends
that women getting treatment for early-stage breast cancer have a
"thorough discussion with their physicians on the pros and cons of
The findings come just a week after presenters at a national
conference found that women who had brachytherapy had double the
rate of mastectomy later on compared with women who got whole
breast irradiation. That study was led by Dr. Benjamin Smith of
M.D. Anderson Cancer Center in Houston and presented at the San
Antonio Breast Cancer Symposium
U.S. National Cancer Institute has more on radiation therapy for
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