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What are the advantages or disadvantages of high dose rate brachytherapy?
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MattKatzMD (Physician - Oncology - Radiation (Verified) ) - 08 / 18 / 2011
Good question. Advantages of HDR breast brachytherapy for partial breast irradiation (PBI) include shorter treatment time, radiation exposure to less normal tissue, and that may translate into fewer side effects (not yet proven). Anecdotally, external beam PBI has had an issue with rib fractures so I've leaned toward HDR for PBI, though it can occue with either.
That's a good lead-in to disadvantages. The dose each treatment is higher and given twice a day, so there is the potential for higher injury to that more focused area of tissue. The other issue is concern that by not irradiating the entire breast, some cancer cells might not be treated and lead to a higher risk of cancer coming back within that breast.
The conservative gold standard remains whole breast radiation because of the overall low toxicity and highly effective results to prevent cancer recurrence. The strongest current argument for HDR PBI is convenience, and many doctors want to wait for data from a clinical trial underway now, NSABP B-39/RTOG 0413, before being comfortable to offer it as an alternative standard option.
That's a good lead-in to disadvantages. The dose each treatment is higher and given twice a day, so there is the potential for higher injury to that more focused area of tissue. The other issue is concern that by not irradiating the entire breast, some cancer cells might not be treated and lead to a higher risk of cancer coming back within that breast.
The conservative gold standard remains whole breast radiation because of the overall low toxicity and highly effective results to prevent cancer recurrence. The strongest current argument for HDR PBI is convenience, and many doctors want to wait for data from a clinical trial underway now, NSABP B-39/RTOG 0413, before being comfortable to offer it as an alternative standard option.
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