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A literature review of the role of brachytherapy in the management of early-stage breast cancer

Published online by Cambridge University Press:  30 September 2019

Rebecca Thorpe Open the ORCID record for Rebecca Thorpe [Opens in a new window]  and
Heather Drury-Smith
Rebecca Thorpe*
Affiliation:
Sheffield Hallam University, Sheffield, UK
Heather Drury-Smith
Affiliation:
Sheffield Hallam University, Sheffield, UK
*
Author for correspondence: Rebecca Thorpe, Faculty of Health and Wellbeing, Sheffield Hallam University, Robert Winston Building, Collegiate Campus, Broomhall Road, Sheffield S10 2BP, UK. E-mail: Rebecca.E.Thorpe@student.shu.ac.uk
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Abstract

Background:

This review evaluates whether brachytherapy can be considered as an alternative to whole breast irradiation (WBI) using criteria such as local recurrence rates, overall survival rates and quality of life (QoL) factors. This is an important issue because of a decline in local recurrence rates, suggesting that some women at very low risk of recurrence may be incurring the negative long-term side effects of WBI without benefitting from a reduction in local recurrence and greater overall survival. As such, the purpose of this literature review is to evaluate whether brachytherapy is a credible alternative to external beam radiation with a particular focus on the impact it has on patient QoL.

Methods:

The search terms used were devised by using the Population Intervention Comparison Outcome framework, and a literature search was carried out using Boolean connectors and Medical Subject Headings in the PubMed database. The resultant articles were manually assessed for relevance and appraised using the Scottish Intercollegiate Guidelines Network tool. Additional papers were sourced from the citations of articles found using the search strategy. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence website. This process resulted in a total of 30 sources being included as part of the review.

Results:

Three types of brachytherapy were the foundation for the majority of the papers found: interstitial multi-catheter brachytherapy, intra-cavity brachytherapy and permanent seed implantation. The key themes that arose from the literature were that brachytherapy is equivalent to WBI both in terms of 5-year local recurrence rates and overall survival rates at 10–12 years. The findings showed that brachytherapy was superior to WBI for some QoL factors such as being less time-consuming and equal in terms of others such as breast cosmesis. The results did also show that brachytherapy does come with its own local toxicities that could impact upon QoL such as the poor breast cosmesis associated with some brachytherapy techniques.

Conclusion:

In conclusion, brachytherapy was deemed a safe or acceptable alternative to WBI, but there is a need for further research on the long-term local recurrence rates, survival rates and quality of life issues as the volume of evidence is still significantly smaller for brachytherapy than for WBI. Specifically, there needs to be further investigation as to which patients will benefit from being offered brachytherapy and the influence that factors such as co-morbidities, performance status and patient choice play in these decisions.

Keywords

brachytherapybreast cancerexternal beam irradiationquality of liferadiotherapy
Type
Literature Review
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 3 , September 2020 , pp. 281 - 290
Copyright
© Cambridge University Press 2019

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