The Coalition for the Advancement of Brachytherapy (CAB) has reviewed recent media reports stemming from a study originally presented in December 2011 by physicians associated with the University of Texas MD Anderson Cancer Center. The study compared the efficacy of whole breast irradiation (WBI) to accelerated partial breast irradiation (APBI), including the use of brachytherapy to treat select patients with early stage breast cancer. CAB believes that the methodology used in the MD Anderson study is misleading as it utilizes a Medicare billing claims database that does not include patient risk stratification data and therefore is not appropriate to use to compare outcomes and toxicities of ABPI to that of whole breast irradiation (WBI).
The treatments examined utilize different methodologies for delivering radiation therapy following surgery for the treatment of breast cancer. APBI delivers a targeted radiation therapy to select low risk patients over a five-day period. Whereas WBI delivers a broader radiation therapy whereby the entire breast is treated over the course of 30-40 days. The conclusions reached regarding the relative efficacy of the two forms of treatments are based completely on a retrospective study of insurance billing claims. This retrospective study fails to take into account key patient clinical characteristics, including, but not limited to pathology and staging, which determine risk assignment of a patient. Further, the billing code data was collected from patients treated from 2000 through 2007. Since that time, advances in brachytherapy product design, physics planning and delivery of dose have led to greater precision and accuracy of radiation treatment with improved outcomes.
CAB contends that it is impossible to draw any meaningful comparisons or conclusions without taking into consideration patient risk assessments. Counter to the findings in the MD Anderson study are multiple peer-reviewed publications available supporting the safe and effective use of APBI in appropriately selected patients. The safety and effectiveness of APBI is further supported by the fact that the American Society of Radiation Oncology (ASTRO) reaffirmed its Consensus Statement in 2011 endorsing the use of APBI in appropriately selected patients. The ASTRO APBI Consensus Statement was originally issued in 2009 based on an exhaustive search of the available medical literature in combination with expert opinion and public comment.
More recent data from a trial comprising over fourteen hundred breast cancer patients, presented on May 5, 2012 at the American Society of Breast Surgeons (ASBrS) Annual Meeting, found that APBI is equally effective, if not more effective, in preventing local breast cancer recurrence than WBI. * This trial’s findings not only contradict the MD Anderson data in finding that tumor control in the breast appears to be similar for APBI and WBI, but suggest that disease control at the initial tumor site may be better with APBI.
Michael Krachon, CAB Chair notes, “The MD Anderson study is by no means sufficient to condemn a promising procedure like APBI brachytherapy. As we await results of the randomized NSABP-B39 Phase III Trial comparing WBI to APBI, physicians should be mindful of the many positive peer-reviewed publications analyzing the efficacy and toxicity associated 2 1455 Pennsylvania Ave. NW, Suite 250, Washington, D.C. 20004 with APBI brachytherapy. The technique has been endorsed by ASTRO in appropriately selected patients, and physicians must take into account the clinical presentation of the patient and their own clinical judgment in the safe and appropriate use of this treatment modality.”
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