Interstitial Brachytherapy For Early-Stage Breast Cancer

Treating breast cancer with external beam radiation is a well-tested method of treatment that can help prevent recurrence, but also affects breast skin, texture, color, and may eventually cause a change in the shape of your breast. Interstitial brachytherapy - which treats breast tissue from inside your breast - doesn't affect your skin, limits radiation to healthy breast tissue, and leaves your breast shape unchanged after a lumpectomy. But the most appealing aspect of breast brachytherapy may be that it can be done in 5 days, instead of 6 to 7 weeks needed for standard external beam radiation.

Interstitial brachytherapy can treat a larger area of breast tissue than intracavity. Multiple brachytherapy catheters can be positioned around the tumor cavity, either during your lumpectomy or a month after surgery. Your doctor will carefully study your treatment needs, plan the best catheter positions and determine the amount of radiation that will work for you. When the catheters are placed, your surgeon will be guided by imaging technology such as CAT scan, ultrasound, or fluoroscope. You can be sure that the radiation will be aimed at the place where cancer cells are most likely to be hiding.

Interstitial breast brachytherapy is done through soft, slender tubes - called catheters - that are strategically placed into your breast tissue. The catheters can be opened at one end during treatment, so radioactive seeds can be threaded into your breast tissue for treatment. Since you may have between 10 and 20 catheters, the seeds can be positioned all around your lumpectomy cavity. As soon as the proper radiation dose has been given, all the seeds are removed and the catheters are closed again. You won't carry the radioactive seeds inside you between treatments.

You may have some mild side effects during breast brachytherapy. Watch out for fatigue, breast soreness, or swelling. Wearing a soft, wire-free bra (or going braless) will make it easier for you to accommodate the catheters. You will be able to drive yourself to the twice-daily radiation appointments, but if you feel better with company, take a supportive friend along.

Once you have finished treatment, the catheters will be removed and you will begin to heal. Have a mammogram at 4-6 months after radiation for a new baseline. About the same time, schedule a clinical breast exam to check on cosmetic appearance, recurrence, and any complications from the radiation treatments. While you're there, tell your doctor about any concerns you have about recurrence after breast brachytherapy. If any dense areas show up on your mammogram, don't panic right away. Having a breast biopsy can sort out a recurrence from an area of fat necrosis.

Smoking before, during, or after radiation treatment is a bad idea. Smoking can result in greater risk of infection and can cause fluid buildup and drainage. Healing can be delayed by smoking - wounds where the catheters were inserted won't close as quickly. Smoking can also cause scabs or dead skin to form around the catheter insertion scars, which may have to be removed by enzyme treatments or surgery. Smoking also raises your risk of breast cancer, so please get help to quit smoking. Your health is worth the effort!

_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.}

_{Skin necrosis in smoking patients receiving partial breast irradiation: two case reports. Edward R Sauter, Steven J Westgate, and Janice Templemire. Cases J. 2008; 1: 230.}

_{Horizon Scanning Technology Prioritising Summary, Multi-catheter interstitial brachytherapy. Australian Government Department of Health and Ageing. October 2007.}

_{Radiation Therapy. The Boost; Pp. 472-474. Dr. Susan Love's Breast Book. Susan M. Love, M.D. Third Edition, 2000.}