Alyssa Mellott

3573 Compare and Contrast

12/9/2013
Effectiveness of MammoSite Brachytherapy
I will be comparing and contrasting two articles that discuss the effectiveness of using
MammoSite brachytherapy. The authors of one study focused on the complications in
comparison to whole breast radiation therapy (WBRT); while the second article states that
partial breast irradiation is linked with low rates of complications and excellent cosmesis
(Shah, 278). When I began studying radiation therapy, I expected it to be very
standardized, so it is interesting to see that there are so many ways to achieve the same
goal and so many debatable methods being used. MammoSite treatments seem very
questionable in some respects but efficient and successful in other cases. Regardless, it is
an option for many early stage breast patients, and some studies seem to discredit it as an
acceptable treatment.
The National Institute of Health published and article that highlights the long-term
complications and toxicities after MammoSite brachytherapy. In the study, women with
WBRT were compared to women with treated with MammoSite. The median follow-up
was 4 years, and the differences in results were very significant. Discrete palpable masses
developed at the lumpectomy site in 26.7% (19 of 71) of the patients in the MammoSite
group compared with 7.3% (18 of 245) of women in the WBRT group (p < 0.001)
(Rosenkranz, 3). The MammoSite patients also developed telangiectasis (spider veins)
more often than WBRT patients. The masses had to be biopsied to rule out malignancy.
Overall, pathology of the biopsied masses revealed fat necrosis, stromal scarring, and
fibrosis in the majority of women treated with MammoSite brachytherapy. A local
recurrence at the lumpectomy site occurred in 2.8% of the patients in the MammoSite

group and in 1.6% of women in the WBRT group (Rosenkranz, 3), and 42% of patients
treated with MammoSite developed a palpable mass, telangiectasia, or both (Rosenkranz,
1). These results display a problematic pattern, and it seems that many breast patients
would not opt for this treatment if they knew the long-term effects. Looking at these
percentages, I know I would not, but there is almost always another side analyze when it
comes to questionable medical treatments.
The second study I found was literally the opposite of the Rosenkranz study. Elsevier
published this article, and it claims excellent cosmesis and low rates of complications. The
authors state that they did this study to test results that claim toxicity and cosmesis
problems associated with MammoSite brachytherapy, like the ones above. This trial used
1665 patients with stage 0-II breast cancer, and they were all treated with MammoSite.
The results show that, the rate of excellent/good cosmesis was 90.6% at 84 months
(Shah, 278). Also, The rate of a complications including symptomatic seroma, infection,
fat necrosis, telangiectasias at 1 year/any time point was 24.2%/38.5% (Shah, 278).
According to authors conclusion, these percentages are not any higher for MammoSite
than WBRT. When considering these results, MammoSite seems to be an ideal treatment.
With two studies that contain such contradictory claims, it is hard to tell which results
are more accurate. Though the Shah study suggests that MammoSite brachytherpay
doesnt cause more complications than WBRT, it is hard to refute the findings that
illustrate higher rates of masses, telangiectasis, and most alarming, a slightly higher rate of
recurrence. Also, the Shah study only used MammoSite patients, and did not directly
compare them to WBRT patients. It seems that the best option for early stage breast CA
patients is to take advantage of the fact there is an alternative to the questionable

procedure in this case. In my opinion, it would be more beneficial to have the WBRT and
avoid any possible long-term disadvantages of MammoSite brachytherapy.

Bibliography

Shah, C., Khwaja, S., Badiyan, S., Wilkinson, J., Vicini, F. A., Beitsch, P., & ... Lyden,
M. (2013). Brachytherapy-based partial breast irradiation is associated with low rates of
complications and excellent cosmesis. Brachytherapy, 12(4), 278-284.
doi:10.1016/j.brachy.2013.04.005

Rosenkranz K, Tsui E, McCabe E, Gui J, Underhill K, Barth R. Increased Rates of

Long-Term Complications after MammoSite Brachytherapy Compared with Whole Breast
Radiation Therapy. Journal Of The American College Of Surgeons [serial online].
September 2013;217(3):497-502. Available from: Academic Search Complete, Ipswich,
MA. Accessed December 6, 2013.