Radiation treatments for early stage breast cancer can be given from the outside or the inside of your breast. Brachytherapy, a type of radiation treatment, uses tiny tubes to deliver the radiation from within your breast to your tumor cavity and a small margin of surrounding tissue. Breast brachytherapy is an effective and fast way to get the treatment you need to prevent recurrence.
Internal Radiation to Prevent Recurrence and Preserve Your Breast
After a lumpectomy for early stage breast cancer, your doctor may prescribe radiation treatments. Radiation breaks the DNA in your cancer cells, so they cannot divide and multiply. Your healthy cells can survive radiation treatments.Before brachytherapy was developed, breast radiation was done with external beam radiation, which involved six or seven weeks of daily treatments. The demands of such a schedule, particularly if the radiation clinic was far away, caused some patients to either skip treatments or opt for a mastectomy.
Breast brachytherapy can be completed with twice-daily treatments for five days. Because this method of radiation takes less time than external beam radiation, it is also called accelerated partial breast irradiation (APBI).
How Breast Brachytherapy Is Done
Each method of breast brachytherapy uses catheters (tiny tubes) placed temporarily inside your breast. These catheters may be inserted separately or as a bundle, or they may be housed inside a flexible balloon.There are two main techniques for doing breast brachytherapy: interstitial and intracavity. Your doctor will help you decide which works most effectively in cases like yours.
Interstitial Brachytherapy: Soft catheters (tiny tubes) may be inserted into your breast separately or in a bundle through one incision. These catheters may be implanted during your lumpectomy surgery, or later as an outpatient procedure. Interstitial brachytherapy may be used to give you a booster dose after a course of external beam radiation, or may be used as the only method of breast radiation.
Interstitial Catheters:
Intracavity Brachytherapy: Also called balloon catheter radiation, this type of device uses a saline-filled balloon with one or more catheter lines. The balloon is inflated after it is placed inside your breast, and it holds the treatment catheters in place. This brachytherapy device may be implanted during your lumpectomy surgery or several weeks later. Intracavity brachytherapy can be used as your only method of breast radiation.
Intracavity Balloon Catheters:
- Mammosite Single Lumen Balloon Catheter
- Contura Multi-Lumen Balloon Catheter
- Axxent Electronic Brachytherapy
Good Candidates for Breast Brachytherapy
In order to qualify for brachytherapy, you must plan to have a lumpectomy, have clear lymph nodes, have a relatively small tumor, and a specific amount of tissue between your skin and the catheter or balloon.Each device has a variety of specific requirements, and some of the devices can be customized for shape, intensity and duration of dose. Radiation clinics will offer a different selection of brachytherapy devices, so you may have to shop around before finding one you can work with. Your doctor may instead refer you to a couple of radiation oncologists for their opinions.
If your tumor turns out to be larger than expected or your lymph nodes are not clear, you may still be able to have radiation therapy. External beam therapy can be tailored to meet your needs and to spare healthy tissues, in many cases. Discuss both options with your doctor before surgery, so you'll be prepared for either type of treatment.
What to Expect During Breast Brachytherapy Treatment
During each treatment, you will lie comfortably on a treatment table, and your catheter will be connected to a radiation machine. Your radiation dose will be in the form of small radioactive seeds or a miniature x-ray source.The radiation machine will insert your dose though the catheters, allow the treatment to take place and then remove the dose. No radiation remains inside your body between treatments.
You will not be radioactive and you will be able to return to normal activities after treatment. When your five days of brachytherapy are over, the catheter is removed, and the incision is cleaned and closed.
Sources:
Long-term cosmetic results and toxicity after accelerated partial breast irradiation: a method of radiation delivery by interstitial brachytherapy for the treatment of early-stage breast carcinoma. Chen, P.Y., et al., Cancer, 2006. 106(5): p. 991-9.
Initial outcomes for patients treated on the American Society of Breast Surgeons MammoSite clinical trial for ductal carcinoma-in-situ of the breast. Jeruss, J.S., et al., Ann Surg Oncol, 2006. 13(7): p. 967-76.
