Association Between Treatment With Brachytherapy vs Whole-Breast Irradiation and Subsequent Mastectomy, Complications, and Survival Among Older Women With Invasive Breast Cancer

• Published in: JAMA : the journal of the American Medical Association 2012-05, Vol.307 (17), p.1827-1837
• Main Authors: Smith, Grace L, Xu, Ying, Buchholz, Thomas A, Giordano, Sharon H, Jiang, Jing, Shih, Ya-Chen Tina, Smith, Benjamin D
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Brachytherapy; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Cancer; Clinical outcomes; Cohort Studies; complications; Fat Necrosis; Fee-for-Service Plans; Female; Females; Humans; Irradiation; Mastectomy - statistics & numerical data; Mastectomy, Segmental; Mortality; Multivariate Analysis; Neoplasm Invasiveness; Odds Ratio; Older people; Pain; Radiation Injuries; Radiation therapy; Retrospective Studies; Rib Fractures; Risk; survival; Survival Analysis; Womens health
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2012.3481

CONTEXT Brachytherapy is a radiation treatment that uses an implanted radioactive source. In recent years, use of breast brachytherapy after lumpectomy for early breast cancer has increased substantially despite a lack of randomized trial data comparing its effectiveness with standard whole-breast irradiation (WBI). Because results of long-term randomized trials will not be reported for years, detailed analysis of clinical outcomes in a nonrandomized setting is warranted. OBJECTIVE To compare the likelihood of breast preservation, complications, and survival for brachytherapy vs WBI among a nationwide cohort of older women with breast cancer with fee-for-service Medicare. DESIGN Retrospective population-based cohort study of 92 735 women aged 67 years or older with incident invasive breast cancer, diagnosed between 2003 and 2007 and followed up through 2008. After lumpectomy 6952 patients were treated with brachytherapy vs 85 783 with WBI. MAIN OUTCOME MEASURES Cumulative incidence and adjusted risk of subsequent mastectomy (an indicator of failure to preserve the breast) and death were compared using the log-rank test and proportional hazards models. Odds of postoperative infectious and noninfectious complications within 1 year were compared using the χ2 test and logistic models. Cumulative incidences of long-term complications were compared using the log-rank test. RESULTS Five-year incidence of subsequent mastectomy was higher in women treated with brachytherapy (3.95%; 95% CI, 3.19%-4.88%) vs WBI (2.18%; 95% CI, 2.04%-2.33%; P