title: A comparison of complication rates in early-stage breast cancer patients treated with brachytherapy versus whole-breast irradiation.
abstract: BACKGROUND
  The adoption of breast brachytherapy into clinical practice for early-stage breast cancer has increased over the last several years. Studies evaluating complication rates following treatment with brachytherapy have shown conflicting results. We compared local toxicity in patients treated with brachytherapy with those treated with whole-breast irradiation (WBI).
  
  
  METHODS
  We identified 417 early-stage breast cancer patients treated with breast-conserving surgery and radiation between 2004 and 2010, and compared 271 women treated with intracavitary brachytherapy with 146 women treated with WBI. Long-term complications were assessed using Kaplan-Meier curves with the log-rank test.
  
  
  RESULTS
  Median follow-up was 4.6 years, and the 5-year incidence of infectious skin complications (9.7 vs. 11.0 %, p = 0.84), abscess (1.1 vs. 0 %, p = 0.15), telangiectasia (8.0 vs. 5.3 %, p = 0.35), and breast pain (14.2 vs. 9.4 %, p = 0.2) was similar between the brachytherapy and WBI cohorts. The brachytherapy cohort had a higher 5-year rate of seroma (46.5 vs. 18.5 %, p < 0.001), and fat necrosis (39.5 vs. 24.4 %, p < 0.001). Brachytherapy patients trended towards more frequent biopsies as a result of fat necrosis to rule out a recurrence (11.2 vs. 6.7 %, p = 0.13).
  
  
  CONCLUSIONS
  Patients treated with intracavitary brachytherapy had more local toxicity, particularly seroma and fat necrosis. Patients should be counseled on the possible increased rate of long-term complications associated with brachytherapy treatment.
authors.affiliation: Department of Surgery, The Bryn Mawr Hospital, Bryn Mawr, PA, USA.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Ajkay
authors.forename: Abigail E
authors.initials: AE
authors.lastname: Collett
authors.forename: Erica V
authors.initials: EV
authors.lastname: Bloomquist
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Gracely
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Frazier
authors.forename: Andrea V
authors.initials: AV
authors.lastname: Barrio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000150:complications* / Q000473:pathology / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000150:complications / Q000473:pathology / Q000532:radiotherapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000150:complications / Q000473:pathology / Q000532:radiotherapy; D018275:Carcinoma, Lobular / Q000150:complications / Q000473:pathology / Q000532:radiotherapy; D005218:Fat Necrosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology*; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology*