Letter from the Editor-in-Chief

Dear Colleagues,



In recent months, much attention has been devoted to a material presented firstly at San Antonio Breast Symposium (November 2011), published as an article on May 2, 2012 in the JAMA, entitled “Association between treatment with brachytherapy vs. whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer”. Authors from the MD Anderson Cancer Center reported a small but statistically significant increase in the rate of mastectomies in elderly patients treated with APBI-brachytherapy as compared to conventional WBI. The rate of mastectomy was nonetheless very low in both groups (2.2% for WBI vs. 4% for APBI-brachytherapy). Authors concluded that “In a cohort of older women with breast cancer, treatment with brachytherapy compared with WBI was asso­ciated with worse long-term breast preservation and increased complications but no difference in survival”. In American Brachytherapy Society response we can read that “there are several weaknesses in this article which need to be acknowledged. The report is based upon a review of Medicare claims data and, as such, is subject to limits in interpretation due to the retrospective nature and inherent selection bias. From prior analyses, we know that Medicare claims data are severely limited when it comes to extracting critically important prognostic factors such as the general medical condition of the patient and the extent of the tumor. Furthermore, critical details regarding other treatments that patients may have received such as the completeness of the initial breast tumor lumpectomy, the systemic therapy received, and the reason for subsequent mastectomy are often lacking. In short, the analysis presented in JAMA tells us very little. This is in stark contrast to the results of many carefully performed studies of APBI-brachytherapy accumulated over twenty years. Peer-reviewed randomized clinical trials are the gold standard of scientific evidence to establish the safety and efficacy of medical interventions. It is important to emphasize that two such studies are available that have demonstrated equivalence of APBI-brachytherapy in comparison to WBI for local control, complications, and cosmetic...


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