This is bad news for those of us who underwent brachytherapy

LuvRVing · December 2011

http://www.medpagetoday.com/MeetingCoverage/SABCS/30058?pfc=101&spc=224

News coming out of the San Antonio Breast Cancer Symposium strongly suggests that Mammosite and other brachytherapy protocols are less effective than standard radiation protocols.

"Women had almost double the risk of mastectomy when they received brachytherapy instead of whole-breast irradiation after conservative surgery for early breast cancer, investigators reported here.

Five years after initial treatment, women who opted for brachytherapy had a 4% mastectomy rate compared with 2.2% among women who received radiation to the entire breast.

Brachytherapy also was associated with higher complication rates, including hospitalization and infection, Benjamin D. Smith, MD, reported at the San Antonio Breast Cancer Symposium...."

There is more. Higher rates of recurrence than standard radiation protocols is the biggest thing.

MD Anderson did the study using records from more than 130,000 patient records aged 66 and above.

How much does this suck for those of us who had brachytherapy? And I am one of the statistics. I had Mammosite in July 2010, had a recurrence or "missed" residual breast cancer that spread to my nodes, had a BMX in April 2011, DD chemo and now radiation again.

Everything I read prior to treatment indicated that brachytherapy was at least AS EFFECTIVE as external radiation and maybe even better. I didn't browbeat my RO into letting me have it, I was told that if my initial tumor was less than 3 cm, I would qualify. And it was 1.7 with no node involvement, so I proceeded with having Mammosite.

Those of you who, like me, have had brachytherapy...be sure your oncologist keeps a close watch on your preserved breast.

voraciousreader · December 2011

Luv...No sooner than a few seconds after the presentation was over...The folks over at Johns Hopkins issued a press release that pretty much said, "Told Ya!" The folks at Johns Hopkins have been critical of the procedure for years and have been refusing to participate in brachytherapy trials.

I wish all of the sisters well who chose brachytherapy. And I agree...they must now be especially vigilant.

katj58 · December 2011

Wow! How strange and what terrible timing! I too, underwent brachytherapy in August 2008. We are almost identifical in our disease except I had two lymph node involvement with micromestatis and was told I was an excellent candidate. Oct. 21, 2011 I was given a diagnosis of recurrent malignant TNBC and it's returned in the axilliary area. I currently underwent 3 biopsies a couple of days ago. Am waiting for results. My life is upside down last couple of months emotionally. Thank God I have a wonderful family to help me get thru this. Facing chemo in a week and after 5 mos. possibly BMX.

voraciousreader · December 2011

SABCS: Limiting Radiation Increases Mastectomies

By Charles Bankhead, Staff Writer, MedPage Today
Published: December 06, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

SAN ANTONIO -- Women had almost double the risk of mastectomy when they received brachytherapy instead of whole-breast irradiation after conservative surgery for early breast cancer, investigators reported here.

Five years after initial treatment, women who opted for brachytherapy had a 4% mastectomy rate compared with 2.2% among women who received radiation to the entire breast.

Brachytherapy also was associated with higher complication rates, including hospitalization and infection, Benjamin D. Smith, MD, reported at the San Antonio Breast Cancer Symposium.

"Our findings show that there are tradeoffs involved in the selection of a radiation therapy technique, and patients need to be aware of these tradeoffs," Smith, of MD Anderson Cancer Center in Houston, told MedPage Today.

Action Points

This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Explain that women had almost double the risk of mastectomy when they received brachytherapy instead of whole-breast irradiation after conservative surgery for early breast cancer.
Point out that brachytherapy also was associated with higher complication rates, including hospitalization and infection.

The findings emphasize the need to wait for mature data from randomized clinical trials before widespread use of brachytherapy for early breast cancer, he added.

Use of breast brachytherapy increased from fewer than 1% of early breast cancer cases in 2000 to 13% in 2007 (P<0.001), which was the period covered by the study.

A radiation oncologist at Johns Hopkins University seconded Smith's call for caution about widespread use of breast brachytherapy.

"We at Johns Hopkins have been opposed to treating people with partial breast irradiation for these exact reasons," Richard Zellars, MD, wrote in an email to MedPage Today and ABC News.

"Without carefully done studies to support treatment recommendations, providers of accelerated partial breast irradiation [APBI] may in fact be harming these patients as this [study] suggests. Most likely, better patient selection is needed," he said.

Smith and colleagues presented results from a retrospective review of outcomes for women who had partial breast irradiation with brachytherapy or whole-breast irradiation. They used Medicare claims data to identify all patients older than 66 with newly diagnosed invasive breast cancer during the study period.

The researchers limited the review to patients who had conservative breast surgery as opposed to upfront mastectomy.

The primary outcome of interest was subsequent mastectomy (a surrogate for disease recurrence) during follow-up.

The analysis included 130,535 women. Patients who had APBI tended to be older and white; to have more comorbidities; and were less likely to have axillary lymph node involvement or to have received chemotherapy.

In a multivariate analysis, the difference in five-year mastectomy rates translated into a hazard ratio of 2.14 for brachytherapy versus whole-breast irradiation (P<0.001).

Additionally, 9.6% of brachytherapy patients required hospitalization during follow-up, compared with 5.7% among women who had whole-breast irradiation. The brachytherapy group also had a higher infection rate (8.1% versus 4.5%, P<0.001).

The cumulative five-year incidence of several other complications occurred significantly more often (P<0.001) in women treated with breast brachytherapy, including rib fracture (4.2% versus 3.7%), fat necrosis (9.1% versus 3.7%), and breast pain (14.9% versus 11.7%). Pneumonitis occurred more often among women who had whole-breast irradiation (0.8% versus 0.1%, P<0.001).

Smith acknowledged that a major limitation of the study was the fact that the time period reviewed represented early clinical experience with breast brachytherapy. Repeating the study and limiting the review to later experience might have changed the results.

"It's entirely possible that the results would have been different," said Smith. "It's also possible that the results would have been the same or possibly worse than what we found. We just don't know."

Smith also acknowledged that brachytherapy is not the only form of APBI, and results with one or more of the other forms of radiation might have turned out differently.

Several large randomized trials comparing APBI and whole-breast irradiation are under way around the world, including a large study in the U.S. that has accrued 4,000 patients thus far. Those types of studies will determine whether outcomes are different with APBI and whole-breast irradiation. However, the results will not be ready for detailed analysis for several years, said Smith.

LuvRVing · December 2011

Dana Farber doesn't do it, either. Wish I had known. I would have had standard rads and probably wouldn't have gone through the hell that has been 2011. I've never filed a medical malpractice lawsuit before, but I have been harmed by this procedure. I'm permanently disabled and my predicted lifespan has been shortened by becoming stage 3b rather than the stage 1 I started at. And I now have up to a 50% chance of spontaneous fractured ribs because I am undergoing a second course of radiation. Might be time to talk to an attorney.

voraciousreader · December 2011

Yikes! I am so sorry to hear this.....

madpeacock · December 2011

Well, that's just great news. I completed my brachytherapy in October. I'm still two months out until my first post BC mammo...

kuchagirl · December 2011

Hold on. I had the brachytherapy in 2007 and am about to reach my 5-year-mark with no indication of recurrence. I haven't had a single problem since treatment ended. I do think that I was a well-selected patient, so I can't speak to anybody else's situation.

I also want to say that of course there is a higher rate of infection - brachytherapy involves invasive cutting of the breast. I almost compulsively changed the dressing on my catheters EVERY DAY, which was more than the nursing staff offered to do, and on my last day the nurse noted that I didn't have any infection, and that most ladies doing brachytherapy had a oozing, pussing breast by the last day. (I wish I had known that before, but at least my actions kept an infection at bay.)

Also, it was clearly explained to me about the risk of fat necrosis, so it's not a surprise that there is more fat necrosis when you are using high doses of radiation in a small area.

The other things, such as recurrence, broken ribs, and hospitalizations - I don't have anything to say. Overall, I feel good about my experience.

LuvRVing · December 2011

Kuchagirl - I didn't have an infection either. My dressing was changed twice a day by the rad oncology nurse and that included the application of a hefty dose of neosporin twice a day. Also, I was kept on oral antibiotics until about a week after my treatment. So from that perspective, my center did a good job.

But...I had a recurrence or leftovers or whatever within a few months after finishing treatment. Even though I was being closely monitored by my oncologist, breast surgeon and a separate radiologist, I ended up with an aggressive tumor in the same breast that spread to my lymph and mammary nodes. What was a Stage 1 tumor became a Stage 3b disaster. And now after my BMX and DD chemo, I am undergoing rads again, and I have a 50% lifetime chance of spontaneous rib fractures.

Yes, I felt my experience was good at the time. Everything I read indicated that I was a good fit for the procedure (age over 50, tumor less than 3 cm, no nodal involvement) and "supposedly" a procedure that was at least as good, if not better, than traditional radiation protocol.

Choices · December 2011

Received Mammosite radiation in April 2008. (This followed a
lumpectomy. Radiation was followed by chemotherapy and a year on Herceptin.)
Insertion of balloon by surgeon was very painful, found by radiation oncologist
to "not be in the cavity." Reinserted. Infection at catheter opening
took six vigilant weeks to cure after radiation treatment was completed. Cancer
and radiation treatment were to right breast. I have the usual lumps and
recurring soreness over three years later. In January of 2011, I was diagnosed
with mild heart valve problems which progressed rapidly over the last 10
months. Three weeks ago (November 2011) underwent heart surgery to replace both
aortic and mitral valves due to "radiation induced aortitis and radiation
induced valvulopathy." (I am 60 years old.) Connection may be rare, but I
do suggest that women who have had any radiation treatment to the breast stay
in regular contact with a cardiologist.

spitnspunk · December 2011

Thanks LuVRing, I saw your comment in the HAIR topic and came here to read this - well the light bulb just went CLICK as this explains a whole lot!!! See, I had my first post BC mamo last month and got a lot of questions about my radiation, but I got an all clear. Then this week, at my onco follow up he seemed real concerned and kept asking me questions to, but again, I'm told 'all clear'. So AHA, now I understand all the concern. I also heard 'all clear' just a few short months prior to my BC diagnosis in mid 2010 so I don't ever put a lot of faith in those two words anymore. This is just crapola , dang, just one more letdown in this journey, but there's nothing to do but love life and live it while we can...and may we all live to 100+ doing just that.

Vicks1960 · December 2011

I just read the following article disputing the Dec. 6 release of study about brachytherapy

http://www.healthimaging.com/index.php?option=com_articles&view=article&id=30831:experts-peg-md-anderson-breast-radiotherapy-study-as-flawed-misleading

Vickie

LuvRVing · December 2011

Vickie - I read your link. I find it interesting that Dana Farber, Johns Hopkins and MD Anderson all seem to agree about brachytherapy. The big question is...who's following those of us who had brachytherapy and compiling the statistics?

spitnspunk · December 2011

Dang! Thanks for that article. However, in my opinion, of course someone that is "co-principal investigator of the American Society of Breast Surgeons' MammoSite Registry" is going to dispute findings that BT is harmful. Him and all the facilitiest that have equipment to do this procedure have way to much invested in the process, plus the mere hint of something that may not work allows insurance companies to run rampant on claim payments. I think that both articles have flaws and there's a lot more that needs to be looked at and disclosed before any decison can be made one way or the other, but if you ask me, this entire journey is a crap shoot - you're either going to be one of the lucky ones that gets to say 'yay, look at me, I'm a survivor X of years with no problems' or you're going to be one of the ones singing the recoccuring blues. Medicine is a science, always trying to improve and find better solutions, but there are no guarantees to any of us.

LuvRVing · December 2011

Spitnspunk - yes, you're right. And let's not mention the fear of lawsuits by those of us who had failures!

cp418 · December 2011

http://www.healthimaging.com/index.php?option=com_articles&view=article&id=30831:experts-peg-md-anderson-breast-radiotherapy-study-as-flawed-misleading

Experts peg MD Anderson breast radiotherapy study as flawed, misleading

cp418 · December 2011

oops --- sorry for double post!!

Kaara · December 2011

WOW...I have a lot more respect for my BS at this juncture. I wanted the mammosite radiation..had read about it and felt the shorter timeframe was better. He politely discouraged me, saying that he could certainly do it, but didn't like the procedure because of the complications involving the cavity and infection risk. He mentioned nothing about recurrance, but then, this was before the San Antonio meeting. I'm glad I listened to him....I'll just go with the standard at this point!

PS...One thing my BS did tell me is that this procedure is very expensive to do compared to the standard rad treatment.

DebConway · December 2011

I am a recent breast cancer patient and feel comfortable with my decision to have the SAVI brachytherapy. The reoccurence rates versus traditional radiation were clearly explained to me. I live in Indianapolis, Indiana and have the top notch IU Cancer Center to go to. My cancer was on my left side and I did not want to risk damage to my heart as well as the chance of shingles and broken ribs. We all have to make informed decisions based on our feelings and trust God to guide our decisions. I feel blessed to have the absolute best medical team in Indiana. My medical physics doctor comes highly recommended by the person who invented the SAVI device. If I have a reoccurence I trust my doctors will address it. It seems like every day there are opposing opinions on every kind of medical treatment and meds.

This is bad news for those of us who underwent brachytherapy

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