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Balloon-Catheter Brachytherapy an Alternative to Whole-Breast Radiation for Early Breast Cancer: Presented at SSO

By Mary Beth Nierengarten

CHICAGO -- March 17, 2008 -- Patients with early breast cancer who are treated by balloon-catheter brachytherapy (BCB) as an alternative to whole-breast radiation therapy (WBRT) after breast conservation surgery show good to excellent cosmesis up to 5 years after treatment, reports a study presented here March 17 at the Society of Surgical Oncology (SSO) 61st Annual Cancer Symposium.

This study builds on earlier reports that have shown BCB to be similar to WBRT in terms of recurrence rates, cosmesis, and patient satisfaction.

"Both our data and the national registry show excellent numbers," said lead author Elie Schochet, MD, Chief Surgical Resident, Department of Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania, referring to a recently published study of outcomes in over 1,400 patients treated with BCB, based on data from the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trials (Vicini F et al. Cancer. 2008;112:758-66).

According to Dr. Schochet, BCB is one of a number of currently available accelerated radiation therapy techniques being offered to women who may not otherwise choose breast conservation therapy because of the inconvenience of standard radiation therapy.

"[Between] 30% to 60% of women eligible for breast conservation therapy choose mastectomy for various reasons -- among them is the inconvenience of doing a standard course of radiation therapy," said Dr. Schochet. For these women, he suggested, BCB may offer a good alternative that will encourage them to undergo breast conservation therapy and not choose mastectomy, which is "a lot of surgery for tumours that will not kill."

In the study, 217 patients with ductal carcinoma in situ (DCIS) and/or invasive T1-T2 breast cancer were treated with BCB following lumpectomy. At a mean follow-up of 33.6 months (range 4-69 months), cosmesis was good to excellent in 94% of 208 evaluable patients. Only 1.4% had poor cosmesis.

Good to excellent cosmesis remained consistent over time, ranging from 94% at 1 month following treatment to 95% at 2 years to 100% at 5 years.

Inferior cosmesis was correlated to acute skin changes in the first year after treatment, and subcutaneous changes significantly correlated with cosmesis at longer follow-up (P = .001). According to the authors, these acute skin changes and late subcutaneous tissue changes remain "a therapeutic challenge."

A technical challenge that remains to minimise toxicity is determining the optimal skin-to-catheter distance (SCD) for BCB. In a second study presented at the SSO meeting by Dr. Schochet and colleagues, the authors concluded that "it is reasonable to attempt a 1-cm margin; however, 5-to-10-mm SCD should still provide a good cosmetic outcome and not preclude full treatment."

Although Dr. Schochet does not think that BCB will replace standard radiation therapy, he expressed his belief that it will be of value to women who are reluctant to undergo breast conservation therapy because of the inconvenience of the 7-week course of standard radiation therapy. For these women, BCB appears to be a feasible option.

[Presentation titles: Cosmesis and Radiation Toxicity Following Balloon Catheter Brachytherapy in Early Breast Cancer. Abstract P38. Is There an Optimal Skin to Catheter Distance for Balloon Catheter Brachytherapy in Breast Cancer? Experience Over Five Years. Abstract P147]

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