Brachytherapy offers alternative to breast cancer patients with implants

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CHICAGO—Women with early-stage breast cancer who have undergone breast augmentation may be treated successfully with partial-breast radiation treatment brachytherapy, according to a study presented today at the 94th annual meeting of the Radiological Society of North America (RSNA).

Patients treated with brachytherapy have better cosmetic outcomes and avoid the risk of the implant hardening, compared to patients who undergo whole-breast radiation therapy, according to the researchers.

Robert R. Kuske Jr., MD, clinical professor at the University of Arizona Health Sciences Center and radiation oncologist at Arizona Oncology Services in Scottsdale, Ariz., who reported the findings, said that one in eight women who undergo breast augmentation will develop breast cancer at some point in their lives.

According to the American Society of Plastic Surgeons, breast augmentation is the most popular cosmetic surgery in the United States with 347,500 procedures performed in 2007. This represents an increase of 64 percent since 2000.

The most common breast cancer treatment for patients with breast implants is skin-sparing mastectomy and implant exchange, according to Kuske. Whole-breast radiation therapy after lumpectomy is an option, but he said that it carries a substantial risk during the healing process of scar tissue wrapping around the implant, causing it to become rock-hard and extremely painful. The condition—capsular contracture—distorts the appearance of the breast.

Kuske set out to determine if partial-breast radiation with brachytherapy might offer a better outcome for women with implants wishing to avoid mastectomy.

He said that scar tissue is minimal, the implant remains unaffected and treatment time is shortened from six-and-a-half weeks with whole-breast radiation therapy to five days with brachytherapy.

For the study, 65 women who were diagnosed with small, early-stage malignant tumors were treated with brachytherapy after a lumpectomy. The women received two doses per day, separated by six hours over a five-day period. Follow-up was six months to five years, according to Kuske.

The researchers found that none of the patients experienced tumor recurrence during the follow-up period. They determined that cosmetic outcome was “good to excellent” in 100 percent of patients with 95 percent judged excellent. Implant hardening was not observed in any of the patients.

“Compared to traditional treatments, brachytherapy offers an excellent alternative for these women,” Kuske said. “It offers very high rates of tumor control with fewer side effects and is easier on their lifestyle.”

Kuske disclosed that he is a consultant for Nucletron and Cianna Medical.