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American Brachytherapy Society
www.americanbrachytherapy.org
For Immediate Release
NEW RADIATION TREATMENT FOR BREAST CANCER IMPROVES BREAST CONSERVATION AND QUALITY OF LIFE
February 2002, Oak Brook, IL -- Brachytherapy for selected early stage breast cancer is an innovative treatment approach that may increase breast conservation, and also reduce the need for mastectomy. Treatment time for breast brachytherapy takes five days instead of six weeks for traditional radiation, according to physicians from the American
Brachytherapy Society (ABS).
“Breast brachytherapy as the sole method of radiation following lumpectomy is a new treatment approach that offers breast conservation with improved convenience of treatment delivery,” said Douglas Arthur, M.D., associate professor at the MCVH of Virginia Commonwealth University Health Systems.
Although most women with breast cancer are candidates for standard breast conservation treatment and can be treated with lumpectomy and external radiation, only a subgroup of these women will be candidates for breast brachytherapy, according to Dr. Arthur. However, even with strict selection criteria it is estimated that 71,000 women each year would be candidates for breast brachytherapy.
Breast conservation treatment has long since been established as an effective treatment alternative to mastectomy for early stage breast cancer. Standard breast conservation treatment consists of breast conserving surgery for tumor removal (lumpectomy) followed by external radiation to the whole breast. Although this treatment approach offers many advantages over mastectomy and provides in-breast cancer control rates that approach 95 % - 100% with good to excellent cosmetic results in nearly all patients, the standard six weeks of daily treatment has proved prohibitive for some patients. As a result, some women refuse external radiation – putting themselves at higher risk for recurrence – or choose mastectomy and have the breast unnecessarily removed. Those finding six weeks of daily treatment inconvenient or impossible include working women, elderly patients and those who live a significant distance from a treatment center.
About Brachytherapy
Brachytherapy is a radiation treatment approach that has been used for treatment of cancer for over 100 years. Specifically, brachytherapy for breast cancer is the use of radioactive sources that are placed temporarily or permanently into the target cancerous tissues or cavities being treated. The technique allows the radiation oncologist to focus the radiation into a defined target and avoid delivering radiation to surrounding various many different locations of the body.
Initially brachytherapy for breast cancer was used in addition to five weeks of external radiation to boost a portion of the breast to higher doses. However, over the past 10 years, the application of brachytherapy in breast cancer has changed. In early stage breast cancer, research has shown that the area that requires radiation treatment to prevent the cancer from returning is the breast tissue that surrounds the area where the initial cancer was removed. Because this typically includes only one-third to one-half of the breast, brachytherapy is now being used to treat the targeted portion of the breast and as a result allows accelerated delivery of the radiation dose so that treatment is completed in four to five days.
About Breast Brachytherapy Procedures
Several locations around the country currently offer breast brachytherapy as the sole method of radiation delivery following lumpectomy, including Dr. Robert Kuske (University of Wisconsin in Madison, Wisconsin), Dr. Frank Vicini (William Beaumont Hospital in Detroit, Michigan) and Dr. Douglas Arthur (MCVH of Virginia Commonwealth University Health Systems in Richmond, Virginia). Although there may be some variation in the technique, all follow the same basic principles. As breast brachytherapy only treats the breast tissue surrounding the lumpectomy cavity, patient selection criteria must be used to assure that the area at risk for tumor recurrence will be covered by the brachytherapy treatment. These criteria include the tumor size, tumor type, lymph node status as well as other pathologic characteristics that minimize the risk that cancer cells are in other parts of the breast.
The first step in the brachytherapy procedure is the placement of needles and/or catheters into the area of the breast to be treated. This is usually done under local anesthesia as an outpatient and can be done at the time of lumpectomy or as a separate procedure. The needles/catheters are about the size of a spaghetti noodle and are placed in the area of the lumpectomy cavity. Depending on the technique used it may require 15-20 catheters to assure the target is covered with an even dose of radiation. Once the catheters are placed, the actual treatment can begin following the completion of a day or so of computer planning to determine where and how much radiation will be delivered. The catheters remain in place until the treatment delivery is complete. The only pain felt during the treatment, according to Dr. Arthur, is the limited discomfort that results from the catheters being
present in the breast; the delivery of the radiation is painless.
The radiation dose can be delivered as an inpatient or an outpatient. As an inpatient, radioactive sources are placed into each catheter and remain there for four to five days. The patient is confined to an isolated room with limited visitation. “Some view this as a welcome break from the world,” contends Dr. Arthur, “whereas others are unable to deal with the confinement.”
New technology known as a high dose rate (HDR) remote afterloader now provides an outpatient brachytherapy treatment option. In short, the patient comes to the department for a series of treatments, typically twice a day for four to five days. For each treatment session, the HDR remote afterloader is connected to each of the catheters and a computer driven radioactive source pushed into the catheters for a prescribed amount of time.
After the treatment session is finished, the catheters are disconnected and the patient is free to go until the next treatment session. Following the last treatment session, the catheters are easily removed in the clinic and the treatment area is cleaned and dressed. Some patients are able to carry on their routine daily living activities and work with the catheters in place; however, many take a break during treatment knowing they will be able to return as soon as the catheters are removed.
“Although this may sound and look like a painful experience,” said Dr. Arthur, “most women have limited discomfort with only a few women requiring pain medication.”
While not every patient will be eligible for treatment with breast brachytherapy, it is a viable option for many women who present with early stage breast cancer. This accelerated treatment approach is presently only offered in select locations. However, the ABS anticipates that this will change over the next few years and become a more widely offered treatment option based on the treatment results, the enthusiasm seen from treated patients, and the interest shown by physicians treating breast cancer.
About The American Brachytherapy Society
The American Brachytherapy Society was founded in 1978 to provide insight, rationale, and research into the use of brachytherapy in the treatment of both malignant and benign conditions. The organization consists of physicists, physicians, and others interested in brachytherapy. For more information go to www.americanbrachytherapy.org.
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