On Wednesday, December 7, researchers from the MD Anderson Cancer Center presented an abstract, Partial breast brachytherapy is associated with inferior effectiveness and increased toxicity compared with whole breast radiation in older patients, at the 2011 San Antonio Breast Cancer Symposium. The study was based on Medicare billing claims for more than 130,000 patients over the age of 66 who were diagnosed with early stage breast cancer between 2000 and 2007 and received a lumpectomy and radiation.

Researchers observed a small but statistically significant increase of 1.8 percent in the rate of mastectomies among women who received accelerated partial breast irradiation (APBI) compared to those treated with whole breast irradiation (WBI). In addition, researchers claim brachytherapy was associated with higher rates of infection and increased toxicity.

Since the release of the abstract, members of the medical community - including professional organizations like the American Society of Breast Surgeons (ASBS), American Brachytherapy Society (ABS) and the American Society for Radiation Oncology (ASTRO) - have spoken out against the conclusions.

According to many physicians, the study design suffers from several shortcomings, making it insufficient for drawing clinical conclusions or influencing current treatment recommendations. In addition, physicians say news reports about the data are misleading and have led to unnecessary anxiety and confusion among women. Read more

• Listen to a webcast featuring four of the world's leading clinical researchers in breast brachytherapy as they provide statements and discuss this controversial new study.

• Read position statements from the major medical societies involved in the research and use of APBI: ASBS, ABS and ASTRO.

From oncoplastic surgery to the Z11 trial, 2011 has seen no shortage of discussion topics among healthcare professionals who offer APBI.

In case you missed them, here are our top stories from 2011, featuring some of today's leading brachytherapy experts.

To view full issues of BrachyBytes, click here.

Though oncoplastic surgery is well recognized to improve surgical outcomes in a safe and effective manner, only in the past decade has this approach gained widespread acceptance and enthusiasm in the United States.

In Part 1, breast surgeon Gail Lebovic, MD - a pioneer in the field of oncoplastic surgery - shares her views on this emerging subspecialty, including the need for formal training and the importance of multi-disciplinary care. Full story

In Part 2, world-renowned brachytherapy expert Robert Kuske, MD gives a radiation oncologist's perspective on the topic - including why partial breast radiation and oncoplastic surgery are not mutually exclusive treatment options. Full story

In the final installment of our series, surgeon Jane Kakkis, MD, discusses her surgical techniques for combining a single-entry brachytherapy device with oncoplastic surgery, how SAVI works better than a balloon and why localized radiation should be offered to women traditionally considerd to be "high-risk." Full story

A panel of radiation oncologists and physicists discuss how the evolution of breast brachytherapy technology changed what constitutes a good treatment plan and the dosimetric criteria they currently utilize in order to achieve better patient outcomes. Full story

While some institutions have already embraced the findings from the ACSOG Z0011 trial, others are hesitant to incorporate practice changes without additional evidence. Two of the study's lead authors, Pat Whitworth, Jr., MD, FACS, and Peter Beitsch, MD, FACS, discuss the significance of the trial, its surrounding controversy, and what it could mean for the future of breast cancer management.
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