Carolyn J. Presley, M.D., from Yale University in New Haven, Conn., and colleagues examined brachytherapy treatment patterns and associated complications in a national sample of Medicare beneficiaries aged 66 to 94 years who underwent breast-conserving surgery from 2008 to 2009 and were treated with brachytherapy or whole breast irradiation (WBI). National treatment variation was assessed using hospital referral regions (HRRs). Complications were compared for brachytherapy and WBI at one year of follow-up.

The researchers found that 15.8 percent of 29,648 women received brachytherapy, with the percentage of women receiving brachytherapy varying from 0 to over 70 percent by HRR. Significantly more women treated with brachytherapy had a complication (34.3 percent), compared with women treated with WBI (18.4 percent). There was a 16.9 percent higher rate of wound and skin complications for women treated with brachytherapy, compared with WBI, but no difference in deep-tissue and bone complications.

"The marked regional variation in utilization suggests that nonclinical factors play an important role in its dissemination," the authors write. "Given the higher costs associated with brachytherapy, the higher risk of complications suggests that clinicians, patients, and policy makers should closely scrutinize the use of this treatment modality."

Two authors disclosed financial ties to Cianna Medical, Fair Health, and/or Medtronic.

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