title: Patterns of use and short-term complications of breast brachytherapy in the national medicare population from 2008-2009.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Yale University School of Medicine, New Haven, CT 06520, USA.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Presley
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Roberts
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.forename: Brigid
authors.initials: B
authors.lastname: Killelea
authors.forename: Beth-Ann
authors.initials: BA
authors.lastname: Lesnikoski
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Long
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D006278:Medicare; D012189:Retrospective Studies; D014481:United States