External beam partial breast irradiation (EB-PBI) is the most cost-effective method for treating postmenopausal women with early-stage
breast cancer-based on utilities, recurrence rates and cost--when compared to whole breast radiotherapy (WBRT) and brachytherapy partial breast irradiation (brachy-PBI)--according to a study in the June 1 issue of the International Journal of Radiation Oncology, Biology, Physics, the official journal of the American Society for Radiation Oncology (ASTRO).
PBI is the newest form of radiation therapy for breast cancer, in which only part of the breast is treated twice a day for four to five days. EB-PBI uses high-energy external X-rays to deliver radiation to the breast after a lumpectomy and brachy-PBI delivers radiation through either implanted needles or a small sphere placed into the post-lumpectomy cavity in the breast.
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Whole breast radiation therapy is currently the standard of care, but it is a time-consuming treatment, involving five to seven weeks of daily treatments, using a linear accelerator to deliver X-rays to the tumor site.
While the convenience of receiving radiation for one week instead of five to seven weeks is obvious, the cost-effectiveness of the different methods of treatment has never been analyzed. Doctors are also still examining long-term data to see whether partial breast irradiation is as effective in curing cancer as whole breast radiation.
In a previous study, researchers at the Harvard Radiation Oncology Program, the Dana-Farber Cancer Institute and Brigham and Women's Hospital Department of Radiation Oncology, the Massachusetts General Hospital Department of Radiation Oncology, and the Brandeis University Heller School for Social Policy and Management, all found that under most circumstances, the quality-adjusted life expectancy was higher in patients receiving PBI than WBRT.
In this study, they sought to determine if PBI is more cost-effective than other treatments.
EB-PBI was found to be significantly more cost-effective than WBRT, (while WBRT was clearly found to be more cost-effective than brachy-PBI).
In fact, WBRT was associated with a cost-effectiveness ratio of $630,000 per quality-adjusted life year in comparison to EB-PBI.A ratio of $50,000 per quality-adjusted life year is considered to be cost-effective.
"In a cost-conscious environment, our results suggest that EB-PBI should be given preference over WBRT for the appropriate patients, and unless the costs associated with brachytherapy are significantly decreased, it cannot be considered a cost-effective treatment," David Sher, M.D., M.P.H., lead author of the study and a radiation oncologist at the Dana-Farber Cancer Institute, said.
He added that partial breast irradiation is still not considered to be the standard of care for treating breast cancer. This being the case, Dr. Sher encourages women interested in the treatment to talk to their radiation oncologists about the risks and benefits of the various treatments available, and to consider enrolling in a clinical trial testing EB-PBI.