Patterns of Use and Short-Term Complications of Breast Brachytherapy in the National Medicare Population From 2008-2009
A partir de données administratives portant sur 29 648 patientes relevant du système d'assurance maladie Medicare et atteintes d'un cancer du sein de stade précoce traité par chirurgie conservatrice entre 2008 et 2009 (âge : 66 à 94 ans ; durée de suivi : 1 an), cette étude américaine analyse l'utilisation de la curiethérapie, puis évalue, par rapport à une radiothérapie du sein entier et à court terme, les complications tissulaires, osseuses et dermatologiques associées
Purpose Brachytherapy has disseminated into clinical practice as an alternative to whole-breast irradiation (WBI) for early-stage breast cancer; however, current national treatment patterns and associated complications remain unknown.
Patients and Methods We constructed a national sample of Medicare beneficiaries ages 66 to 94 years who underwent breast-conserving surgery from 2008 to 2009 and were treated with brachytherapy or WBI. We used hospital referral regions (HRRs) to assess national treatment variation and an instrumental variable analysis to compare complication rates between treatment groups, adjusting for patient and clinical characteristics. We compared overall, wound and skin, and deep-tissue and bone complications between brachytherapy and WBI at 1 year of follow-up.
Results Of 29,648 women in our sample, 4,671 (15.8%) received brachytherapy. The percent of patients receiving brachytherapy varied substantially across HRRs, ranging from 0% to over 70% (interquartile range, 7.5% to 23.3%). Of women treated with brachytherapy, 34.3% had a complication compared with 27.3% of women undergoing WBI (P < .001). After adjusting for patient and clinical characteristics, 35.2% of women treated with brachytherapy (95% CI, 28.6 to 41.9) had a complication compared with 18.4% treated with WBI (95% CI, 15.5 to 21.3; P value for difference, <.001). Brachytherapy was associated with a 16.9% higher rate of wound and skin complications compared with WBI (95% CI, 10.0 to 23.9; P < .001), but there was no difference in deep-tissue and bone complications.
Conclusion Brachytherapy is commonly used among Medicare beneficiaries and varies substantially across regions. After 1 year, wound and skin complications were significantly higher among women receiving brachytherapy compared with those receiving WBI.
Journal of Clinical Oncology , résumé, 2012