One of the leading experts on radiation therapy for breast cancer says a new study in JAMA -- about breast cancer treatment - has misleading information and may unnecessarily deter women from getting breast brachytherapy, a safe and effective treatment.
Dr. Robert Kuske, a pioneer of breast brachytherapy and co-principal investigator on two major clinical trials, is available to respond to the JAMA article. The paper from MD Anderson researchers, which will be published on May 2, reports slightly increased complications for breast brachytherapy (also called accelerated partial breast irradiation, or APBI) compared to whole breast irradiation (WBI).
Dr. Kuske, an outspoken researcher of breast brachytherapy for properly selected patients, points out that the JAMA article compares WBI to an older form of breast brachytherapy with less control of radiation dose. Newer research shows that "single-channel" balloon therapy is being supplanted by "strut-based" brachytherapy that allows the oncologist more flexibility in shaping the dose cloud.
Will the JAMA study, if unchallenged, deny women access to modern breast brachytherapy? Dr. Kuske fears it may do just that and may endanger completion of the long-term, critically important "NSABP B-39" study he co-leads.
Dr. Kuske says that the JAMA article:
•Is not a clinical study and fails to report tumor recurrence rates
•Shows no difference in overall survival between WBI and brachytherapy
•Used data on an older form of brachytherapy that resulted in high skin doses that could explain the difference in side effects and complications
•Shows a difference in mastectomy rates that is only 1.77%
•Is a retrospective review of the Medicare SEER database that is fraught with potential inaccuracy, incomplete information, and sampling bias. Studies from this data base are well-known in the scientific community to have unreliable data.
•Is so flawed in research methods that for the mastectomy data, it is not possible to identify which breast (left or right) was removed or for what reason.
Among advantages of the newer treatment (developed since the data in the JAMA article was compiled), modern brachytherapy can:
•Provide better cosmetic results and fewer side effects
•Precisely target the dose to where it is needed most, reducing radiation exposure to healthy tissue
•Greatly reduce treatment-related fatigue
•Better fit busy women's needs by offering a more targeted therapy and significantly shortening treatment time
•Allow more treatment options if a cancer recurs.
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