Brachytherapy Defenders Challenge JAMA Study as Old News
The purpose of radiation therapy is to spare breast cancer patients the discomfort and disfigurement of a mastectomy. In recent years, a variety of technologies have emerged that offer alternative treatment delivery methods. But how effective are they? A JAMA study published May 2 has caused a stir in the radiation oncology world for criticizing brachytherapy as leaving women open to more numerous and severe complications than did whole-breast irradiation, including: subsequent mastectomy, more frequent post-operative infections, a greater incidence of breast pain, fat necrosis, and fractured ribs. Dr. Constantine Mantz, CMO of 21st Century Oncology in Fort Myers, FL, however, is among the defenders of brachytherapy, and says that radiation oncologists can do a much finer job with a multi-catheter system than with a single-catheter device, as was examined in the study. “Advocates for the whole-breast radiation approach will state that historically ‘this has been the tried-and-true way to treat patients; until those results are available and demonstrate equivalence between the two types of treatment, we can’t demonstrate the standard of care.’” he tells Imagingbiz. But brachytherapy has been around for 15 years, Mantz says, and until long-term data using partial-breast irradiation devices has been accrued, physicians will continue to perfect ways to diminish post-surgical toxicities and better control how radiation is deposited into target areas of the breast. In addition to the multi-catheter approach, which requires a five-day course of treatment, Mantz says that some intrasurgical mega-dose therapies can condense irradiation treatment to one shot right as surgeons are closing. “Any of these partial breast approaches will allow for convenience,” Mantz says. “Determining which subsets of patients are going to be appropriate for either treatment and which subjects should have only a whole-breast irradiation, that’s going to be knowledge that will be known over the next few years,” Mantz said. Breast surgeon Gail Lebovic, past president of the American Society of Breast Disease and a founder and developer of the SAVI multi-catheter brachytherapy device, says that part of the issue with the JAMA study is that medicine has advanced beyond the techniques captured in the research. “We’ve gotten better at reconstruction, and the radiation techniques have gotten a lot better,” she says. “If you save the breast, 80% of the time, the tumor’s going to come back in that exact same spot, and the recurrence rates are about 30% without radiation.” The problem, she says, is that the radiation therapies profiled in the JAMA research aren’t controlled directionally. “It’s old news, basically,” Lebovic says. “It’s kind of like, ‘Well, yeah, we knew that device wasn’t good, and that’s why other companies went on to develop these new devices.’ That’s kind of why I was surprised it was published.” Lebovic says that the important thing for researchers, practitioners, and surgeons to remember is “as usual, there’s no one way to treat breast cancer.” “Patients have different stages of disease, different types of surgery, etc.,” she says. “We need to have multiple techniques available for investment.”