Increased Rates of Long-Term Complications after MammoSite Brachytherapy Compared with Whole Breast Radiation Therapy

Geisel Medical School at Dartmouth, Hanover, NH. Electronic address: .
Journal of the American College of Surgeons (Impact Factor: 5.12). 07/2013; 217(3). DOI: 10.1016/j.jamcollsurg.2013.03.028
Source: PubMed


Due to its short duration of therapy and low rates of local recurrence, women undergoing breast conservation are increasingly opting for partial breast irradiation with the MammoSite (Cytyc/Hologic) catheter. In early follow-up studies, few complications were reported. Few data, however, exist regarding longer-term complications. We compared the long-term local toxicities of MammoSite partial breast irradiation with those resulting from whole breast radiation.
This was a retrospective study performed in a single academic medical center. All patients who underwent breast-conserving surgery between 2003 and 2008, who met institutional criteria for brachytherapy, were included. We compared women treated with MammoSite with patients treated with whole breast radiation therapy (WBRT). Endpoints included incidence of palpable masses at the lumpectomy site, telangiectasias, and local recurrence.
Seventy-one MammoSite patients and 245 WBRT patients were well matched with regard to clinical characteristics. Median follow-up was 4 years. A palpable mass developed at the site of lumpectomy in 27% of the MammoSite patients compared with 7% of the WBRT patients (p < 0.0001). Telangiectasias developed more frequently in the MammoSite group than in the WBRT group (24% vs 4%, p < 0.001). Forty-two percent of patients treated with MammoSite developed a palpable mass, telangectasia, or both.
Palpable masses and telangiectasias are frequent long-term complications after MammoSite brachytherapy and occur at a significantly higher rate after MammoSite brachytherapy than after WBRT. This increased rate of long-term local toxicity should be considered when counseling women on options for adjuvant radiation therapy after breast-conserving surgery.

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    • "The author advised “prompt caution over widespread application of breast brachytherapy”. This assertion is acceptable if we consider brachytherapy technique based on a balloon device (Mammosite™) but not if HIBT is used [36-38]. Recently, the same authors concluded, in an observational study, that brachytherapy shows lesser breast preservation benefit compared with EBRT and that the ASTRO suitability criteria identify patients with the lowest absolute, but not relative, risk of mastectomy [39]. "
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