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Title: Contemporary Toxicity Profile of Breast Brachytherapy Versus External Beam Radiation After Lumpectomy for Breast Cancer

Abstract

Purpose: We compared toxicities after brachytherapy versus external beam radiation therapy (EBRT) in contemporary breast cancer patients. Methods and Materials: Using MarketScan healthcare claims, we identified 64,112 women treated from 2003 to 2012 with lumpectomy followed by radiation (brachytherapy vs EBRT). Brachytherapy was further classified by multichannel versus single-channel applicator approach. We identified the risks and predictors of 1-year infectious and noninfectious postoperative adverse events using logistic regression and temporal trends using Cochran-Armitage tests. We estimated the 5-year Kaplan-Meier cumulative incidence of radiation-associated adverse events. Results: A total of 4522 (7.1%) patients received brachytherapy (50.2% multichannel vs 48.7% single-channel applicator). The overall risk of infectious adverse events was higher after brachytherapy than after EBRT (odds ratio [OR] = 1.21; 95% confidence interval [CI] 1.09-1.34, P<.001). However, over time, the frequency of infectious adverse events after brachytherapy decreased, from 17.3% in 2003 to 11.6% in 2012, and was stable after EBRT at 9.7%. Beyond 2007, there were no longer excess infections with brachytherapy (P=.97). The overall risk of noninfectious adverse events was higher after brachytherapy than after EBRT (OR=2.27; 95% CI 2.09-2.47, P<.0001). Over time, the frequency of noninfectious adverse events detected increased: after multichannel brachytherapy, from 9.1% in 2004 to 18.9% inmore » 2012 (Ptrend = .64); single-channel brachytherapy, from 12.8% to 29.8% (Ptrend<.001); and EBRT, from 6.1% to 10.3% (Ptrend<.0001). The risk was significantly higher with single-channel than with multichannel brachytherapy (hazard ratio = 1.32; 95% CI 1.03-1.69, P=.03). Of noninfectious adverse events, 70.9% were seroma. Seroma significantly increased breast pain risk (P<.0001). Patients with underlying diabetes, cardiovascular disease, and treatment with chemotherapy had increased infectious and noninfectious adverse events. The 5-year incidences of fat necrosis, breast pain, and rib fracture were slightly higher after brachytherapy than after EBRT (13.7% vs 8.1%, 19.4% vs 16.0%, and 1.6% vs 1.3%, respectively), but the risks were not significantly different for multichannel versus single-channel applicators. Conclusion: Toxicities after breast brachytherapy were distinct from those after EBRT. Temporal toxicity trends may reflect changing technology and evolving practitioner experience with brachytherapy.« less

Authors:
 [1];  [1];  [1];  [2]
  1. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
Publication Date:
OSTI Identifier:
22645122
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 94; Journal Issue: 4; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRACHYTHERAPY; CARDIOVASCULAR DISEASES; CHEMOTHERAPY; EXTERNAL BEAM RADIATION THERAPY; MAMMARY GLANDS; NEOPLASMS; PATIENTS; TOXICITY

Citation Formats

Huo, Jinhai, Giordano, Sharon H., Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Smith, Benjamin D., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Shaitelman, Simona F., Smith, Grace L., E-mail: glsmith@mdanderson.org, and Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Contemporary Toxicity Profile of Breast Brachytherapy Versus External Beam Radiation After Lumpectomy for Breast Cancer. United States: N. p., 2016. Web. doi:10.1016/J.IJROBP.2015.12.013.
Huo, Jinhai, Giordano, Sharon H., Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Smith, Benjamin D., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Shaitelman, Simona F., Smith, Grace L., E-mail: glsmith@mdanderson.org, & Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Contemporary Toxicity Profile of Breast Brachytherapy Versus External Beam Radiation After Lumpectomy for Breast Cancer. United States. https://doi.org/10.1016/J.IJROBP.2015.12.013
Huo, Jinhai, Giordano, Sharon H., Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Smith, Benjamin D., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, Shaitelman, Simona F., Smith, Grace L., E-mail: glsmith@mdanderson.org, and Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 2016. "Contemporary Toxicity Profile of Breast Brachytherapy Versus External Beam Radiation After Lumpectomy for Breast Cancer". United States. https://doi.org/10.1016/J.IJROBP.2015.12.013.
@article{osti_22645122,
title = {Contemporary Toxicity Profile of Breast Brachytherapy Versus External Beam Radiation After Lumpectomy for Breast Cancer},
author = {Huo, Jinhai and Giordano, Sharon H. and Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas and Smith, Benjamin D. and Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas and Shaitelman, Simona F. and Smith, Grace L., E-mail: glsmith@mdanderson.org and Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas},
abstractNote = {Purpose: We compared toxicities after brachytherapy versus external beam radiation therapy (EBRT) in contemporary breast cancer patients. Methods and Materials: Using MarketScan healthcare claims, we identified 64,112 women treated from 2003 to 2012 with lumpectomy followed by radiation (brachytherapy vs EBRT). Brachytherapy was further classified by multichannel versus single-channel applicator approach. We identified the risks and predictors of 1-year infectious and noninfectious postoperative adverse events using logistic regression and temporal trends using Cochran-Armitage tests. We estimated the 5-year Kaplan-Meier cumulative incidence of radiation-associated adverse events. Results: A total of 4522 (7.1%) patients received brachytherapy (50.2% multichannel vs 48.7% single-channel applicator). The overall risk of infectious adverse events was higher after brachytherapy than after EBRT (odds ratio [OR] = 1.21; 95% confidence interval [CI] 1.09-1.34, P<.001). However, over time, the frequency of infectious adverse events after brachytherapy decreased, from 17.3% in 2003 to 11.6% in 2012, and was stable after EBRT at 9.7%. Beyond 2007, there were no longer excess infections with brachytherapy (P=.97). The overall risk of noninfectious adverse events was higher after brachytherapy than after EBRT (OR=2.27; 95% CI 2.09-2.47, P<.0001). Over time, the frequency of noninfectious adverse events detected increased: after multichannel brachytherapy, from 9.1% in 2004 to 18.9% in 2012 (Ptrend = .64); single-channel brachytherapy, from 12.8% to 29.8% (Ptrend<.001); and EBRT, from 6.1% to 10.3% (Ptrend<.0001). The risk was significantly higher with single-channel than with multichannel brachytherapy (hazard ratio = 1.32; 95% CI 1.03-1.69, P=.03). Of noninfectious adverse events, 70.9% were seroma. Seroma significantly increased breast pain risk (P<.0001). Patients with underlying diabetes, cardiovascular disease, and treatment with chemotherapy had increased infectious and noninfectious adverse events. The 5-year incidences of fat necrosis, breast pain, and rib fracture were slightly higher after brachytherapy than after EBRT (13.7% vs 8.1%, 19.4% vs 16.0%, and 1.6% vs 1.3%, respectively), but the risks were not significantly different for multichannel versus single-channel applicators. Conclusion: Toxicities after breast brachytherapy were distinct from those after EBRT. Temporal toxicity trends may reflect changing technology and evolving practitioner experience with brachytherapy.},
doi = {10.1016/J.IJROBP.2015.12.013},
url = {https://www.osti.gov/biblio/22645122}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 94,
place = {United States},
year = {Tue Mar 15 00:00:00 EDT 2016},
month = {Tue Mar 15 00:00:00 EDT 2016}
}