The study, let by Frank A. Vicini, MD, program director of radiation oncology at William Beaumont Hospital in Royal Oak, Mich., evaluated 174 women with early-stage breast cancer who received lumpectomy followed by the new implant treatment, referred to as "brachytherapy."

In women who received brachytherapy, the temporary radiation implant was inserted in the tissue of the breast where the tumor had been removed, and was left in place for four to five days. Each brachytherapy patient was matched with another lumpectomy patient who received traditional external-beam radiation therapy (ERT) for six and one half weeks. The median followup for each patient group was three years.

There were no statistical differences found in rates of local recurrence rates between patients who received brachytherapy or ERT. In addition, there were no statistically significant differences found in rates of distant metastasis (spread), disease-free survival, overall survival, or cause-specific survival between the patient groups.

Brachytherapy Takes Less Time than ERT

Vicini says brachytherapy is delivered via small, hollow needles that are placed around the lumpectomy cavity, and the needles are connected to a machine that has a "tiny radioactive source that delivers a concentrated dose of radiation," he says. The radioactive source is then removed from the patient.

"So it is a temporary radiation implant, and there are no radiation safety issues to other [people]," Vicini explains, "and in terms of exposure to the patient, there is actually a reduced amount of radiation for the patient because the radiation is confined to a smaller area."

The major advantage of brachytherapy is that it takes less time than ERT.

"Right now, the major inconvenience of breast-conserving therapy is the six to seven weeks of daily treatment, coming back and forth to a radiation facility," he says. "A lot of these women are getting chemotherapy for three or four months, and then the radiation is tacked on at the end for another month and a half. Certainly, if you could do the radiation immediately after surgery in a week, it makes it a lot easier on patients, especially for patients who have to travel long distances for radiation."

Further Research Is Needed

Vicini says that further research is needed before brachytherapy can be used in actual clinical practice. "We still need to do a longer follow-up on these patients and do a direct trial comparing the two modalities," he notes. "In the next year or two, we hope to do a direct comparison between the brachytherapy-alone patients versus the traditional, whole-breast radiation."

Vicini says he is conducting a pilot study on the use of traditional ERT in only five days, but confining the radiation only to the lumpectomy cavity. He says some women may object to the use of the implants, and using short-term ERT may be an alternative for them.

"Some women don?t like the idea of putting the needles in the breast, and it prevents them from doing the [brachytherapy]," he says. "But certainly, if you can do the technique with machine radiation in only one week, it will be interesting to more women."

There are restrictions for patients who can qualify for brachytherapy. For example, women must have small tumors and involvement of only three or fewer lymph nodes.

"Anywhere from 20 to 40 percent of patients with stage I or stage II would probably qualify for this therapy," Vicini says.

LaMar S. McGinnis, MD, senior medical consultant for the American Cancer Society (ACS) in Atlanta, is encouraged by the study?s results. "I?m very excited about this," he says. "This is something I?ve known about for some time, and it?s good to see it begin to come to fruition."

McGinnis says that if it becomes available, patients would welcome brachytherapy. "I think the idea of being under a radiation therapy machine is very intimidating to a lot of patients," he says. "If [brachytherapy] proves in further trials to be [effective], I can see it replacing the external beam therapy."

A. Marilyn Leitch, MD, professor of surgery in the division of surgical oncology at the University of Texas Southwestern Medical Center, says brachytherapy appears promising, although further research is needed.

"Investigators are always looking for ways to make treatment easier and better tolerated without sacrificing local control of the tumor or survival," she says.