External beam radiation for breast cancer treatment usually takes 5 to 7 weeks. A new kind of brachytherapy (internal beam radiation) takes only 5 to 7 days, with great effectiveness and fewer side effects. Read about balloon catheter radiation and how it may benefit you.
Breast Radiation After Lumpectomy
Radiation is often used to treat breast cancer after your tumor has been removed. If you've had breast-conserving surgery (sometimes called a "lumpectomy"), radiation may be recommended to ensure that cancer cells that may remain in the tumor area are destroyed. Since healthy cells as well as cancer cells in the radiation area will be affected, radiation oncologists have come up with some precise ways to zap your tissues and do the least harm.External and Internal Radiation
You may be treated with external or internal radiation, depending on which method will be most effective. External radiation is also called whole-breast radiation, and is usually given daily for 5 to 7 weeks, in a clinic that specializes in radiology for cancer. Internal radiation (" brachytherapy") is also referred to as partial-breast radiation. It involves placing small radioactive seeds into catheters inside your breast, where the tumor used to be. The radioactive seeds emit the proper treatment dose of energy to the tumor cavity as well as the surrounding tissue.Balloon Catheter Radiation
The Food and Drug Administration (FDA) approved a new technology for brachytherapy called balloon catheter radiation in 2002. For breast radiation, some methods use a balloon, and others use a device that expands like a balloon, once it is placed inside your breast. These methods of partial-breast radiation are gaining acceptance among oncologists, and may be an option for you. Treatment is given for 5 to 7 days, after which the catheter is removed. Because this method of radiation takes less time than external beam radiation, it is also called accelerated partial breast irradiation.Radiation Treatment Goals
The goal of treatment with a balloon catheter device such as MammoSite or ClearPath is to radiate breast tissue in and around the tumor cavity in order to destroy any remaining cancer cells, while limiting irradiation to healthy tissues in your lungs, heart, skin, and fat. Balloon catheters are available as single-source (one catheter containing the radiation dose) and multiple-source models (several catheters containing the radiation doses). Let's look at how one type of multiple-source balloon catheter is constructed and how it works to kill cancer while being kind to your other tissues.ClearPath HDR Balloon Catheter Device
Photo © Pam Stephan
This is the ClearPath Balloon Catheter, with the treatment catheters (tubes) expanded, as they would be inside a breast. In the left half of the picture, you can see the bundle of catheters leading into the "balloon" area. These catheters are divided into two types by function: the outer ring of catheters expands inside the lumpectomy cavity, and pushes tissue away from the inner ring of catheters. The inner ring of catheters contain the radioactive seeds, and during your treatment, will be connected to the machine that delivers a specific dose of radiation. In the middle of the picture, you can see where the catheters are held in a precise placement at the outer cap of the balloon. On the right of the picture is the balloon catheter area.
Balloon Catheter Up Close
Photo © Pam Stephan
Here is a close-up view of the balloon catheter device. "A" shows where the device can be connected during treatment. To the left of the gasket, the bundle of catheters hooks up with the catheters which are inside your breast. The external catheters will be disconnected after each treatment. "B" shows the outer ring of catheters -- these remain expanded during your complete treatment period (5 to 7 days). These catheters can be expanded to custom fit your lumpectomy cavity, to provide space between your tissues and the radioactive material. "C" shows the inner ring of catheters, which will carry the radioactive seeds, when the device is connected to the machine. These seeds are removed when you are not receiving treatment.
Wearing a Balloon Catheter During Treatment
Photo © Pam Stephan
This photo shows ClearPath balloon catheter inserted in a clear plastic torso wearing a front-closing bra. I've added a red line to help you see the outer contour of the breast, and a blue line showing where the balloon catheter might sit within the breast. Notice that outside the breast skin, a cap sits over the gasket where the inner ring of catheters enters the device. If you have a balloon catheter, you will need to wear this outer cap while the device is in place. For each treatment, the protective cap will be removed, and the treatment catheters will be connected to the machine that delivers the radiation. Each session may last from 10 to 15 minutes. Once the session is over, the treatment catheters will be disconnected.
Balloon Catheter Implantation and Treatment Cycle
Illustration © Pam Stephan
A balloon catheter can be implanted at two different times: at the end of a lumpectomy procedure, or with ultrasound guidance to the tumor cavity after surgery has healed. A balloon catheter device can be inserted with local anesthesia. Preparation, placement, and cleanup takes about 25 minutes. The balloon area will not be expanded (see illustration) until it is inside your breast. When your treatments are finished, the catheter can easily be collapsed, removed, and the incision closed with a couple of stitches and a dressing.
Brachytherapy treatments given through a balloon catheter are scheduled twice a day for one week (5 to 7 days). Side effects from this method of radiation are quite mild when compared to external beam radiation.
Balloon Catheter Compares Well With Traditional Radiation
There is very limited data on the new radiation techniques, but studies show that the preliminary and early results look very good. Research reports that with balloon catheter partial breast radiation, little is lost in terms of efficacy, but much gained in terms of convenience. Patients report fewer side effects from radiation, and recovery time may be shorter than external beam or implanted seed radiation.Sources:
Radiological Society of North America. Ultrasound-guided Percutaneous Placement of Balloon Catheters for Partial Breast Irradiation (PBI) after Lumpectomy for Breast Cancer. Lora D. Barke, D.O., et al. November 29 2006.American Society for Therapeutic Radiation and Oncology (ASTRO) Meeting November 2007. A Dosimetric Comparison of MammoSiteTM and ClearPathTM HDR Breast Brachytherapy Devices. Adam Dickler, M.D., et. Al.
American Journal of Surgery. Descriptions and outcomes of insertion techniques of a breast brachytherapy balloon catheter in 1403 patients enrolled in the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Zannis V, et al. 2005 Oct;190(4):530-8.
