Breast Brachytherapy

Breast tumors are often treated with a combination of tumor removal followed by external beam radiotherapy to the whole breast. This has been found in several studies to result in the same cure rate as total breast removal. Sadly, only one third or so of women choose to keep their breast. One of the reasons for this low number may be that the external radiotherapy can take as long as 7 weeks to give, and this can be too much time away from home or work for some women.

Since 1998, Cancer Treatment Centers of America has had a treatment program which uses 5 days of partial breast brachytherapy (temporary radiation implant) instead of 5 - 7 weeks of external beam radiotherapy. This shorter time period is a great benefit to all patients, but especially working women, those who live far away from a radiation treatment center, and those who just want to get the treatment over with as quickly as possible.

The brachytherapy procedure involves placing some flexible plastic catheters (tiny tubes) into the breast. The procedure is performed by a board-certified radiation oncologist (Dr. Kelly or Dr. Flynn), and is done under ultrasound guidance. Nine times over the following 5 days, the catheters are briefly connected to our high-dose-rate brachytherapy machine for an internal radiation treatment through the catheters. These treatments take about 15 minutes each and are painless. On Friday, the catheters are easily removed, and you will be able to go home on the same day. During the 5 days of treatment you will be an out-patient and may stay in a guest room in the building. You will not be radioactive, and can do most of your usual activities during that period. We have nutrition classes and other activities available during the week.

So far, various hospitals in North America have published their early results using similar techniques, with 98% - 100% tumor control rates. The average follow-up for these studies has been short, 20 to 70 months, but these early results are very promising. Some of the potential benefits of brachytherapy are:

The entire treatment takes 5 days instead of 5 - 7 weeks.
The radiation dose is concentrated in the area of the breast where the tumor was previously removed. Less radiation will reach the skin, lungs, heart, ribs, the healthy part of the breast, and the body as a whole.
Because the treatment is so short, the brachytherapy can be given before chemotherapy is started (if chemotherapy is required). Radiation appears to be more effective if it can be given earlier rather than later.
Although brachytherapy is a very popular and proven treatment for cancer, using brachytherapy instead of external beam radiation for breast cancer is a recent idea. Currently, the results from brachytherapy appear to be at least as good as the results seen after whole breast external beam radiotherapy. However, even if the results are approximately the same, brachytherapy still has the advantages of being a shorter treatment, and irradiating less of the body.
We hope that our research will help show that lumpectomy followed by brachytherapy can be an excellent ttreatment choice for breast cancer patients who are trying to keep their breast.

From 1998 through 2001, forty-three women have officially enrolled on the protocol. There has been a 100% cancer control rate in these women so far. Statistically, there has been no worsening of the breast appearance. There has been a statistical improvement in the quality of life. (Based on analysis in January 2002 of all our available results. Results presented at American Brachytherapy Society conference May 2002.)

CTCA's protocol is available for women with stage 1 or stage 2 breast cancer, with a tumor size less than 4 cm (1.5 inches), and negative surgical margins. If the axillary lymph nodes have been removed, there should be less than 4 lymph nodes which contain cancer, and no other reason to irradiate the lymph nodes. There are additional factors which we evaluate to make sure that our brachytherapy program is right for you.

There is a second way to do breast brachytherapy, with the MammoSite RTS (TM) device. A single catheter is inserted into the breast, into the cavity (seroma) where the tumor used to be. A balloon at the end of the catheter is inflated. The high dose rate (HDR) brachytherapy pellet is placed in the center of the balloon, and the surrounding tissue is radiated. This treatment also takes 5 days and has the same benefits as regular breast brachytherapy. The MammoSite device was FDA approved in 2002. This device is usually placed at the time of the lumpectomy or within 6 weeks afterwards. Some women interested in this treatment are finding out that they do not qualify because of breast shape or because they do not have a fluid filled cavity (seroma) remaining in their breast after their lumpectomy. For these women, regular breast brachytherapy can be an excellent option.

If you are interested or would like more information, please call our oncology information specialists at 1-888-771-1670.