New radiation therapy shortens breast cancer procedure to 5 days from 6 weeks
May 27, 2008 08:56AM
After breast cancer surgery, patients typically face an agonizing six weeks of radiation therapy.
A new procedure is giving some the choice of a five-day treatment.
"Normally, we treat the whole breast with radiation," said Dr. Gilbert Padula, a radiation oncologist at The Lacks Cancer Center at St. Mary's Health Care. "But, with this type of procedure, we only treat the cavity left inside the breast by the lumpectomy."
More precise than conventional radiation therapy, accelerated partial breast irradiation or, APBI, using the MammoSite Radiation Therapy System delivers a more concentrated dose of radiation to the site of the tumor while reducing the risk of damage to surrounding healthy breast tissue. The total dose of radiation is equivalent to what patients receive during a full regimen of conventional radiation treatments.
|A new choice The new option -- also known as Accelerated Partial Breast Irradiation (APBI) -- cuts radiation therapy from six weeks to five days. |
1. After the tumor is removed, a small soft balloon attached to a thin catheter is inserted through a small incision and placed inside the cavity left by the lumpectomy. The balloon, along with a small portion of the catheter, is secured to the patient for the duration of the therapy.
2. The balloon is filled with saline solution so that it snugly fills the cavity.
3. Treatment is planned by the radiation oncologist who will take images of the balloon and determine the amount of radiation needed.
4. During treatment, the catheter is connected to a computer-controlled machine that inserts a radiation "seed" into the balloon to deliver the therapy.
5. Once therapy is complete, the seed is removed and the catheter is disconnected from the machine. No radiation remains inside the breast between treatments.
6. After five days of treatment, the balloon catheter is removed through the original incision.
Who can have the procedure?
Women with small, early breast cancers are typically eligible for the APBI procedure. There still is uncertainty about who it is best for and, when there is doubt, the doctor may recommend standard radiation therapy. Generally, the tumor must be small with clear surgical margins after the lumpectomy, and preferably no lymph nodes containing cancer.
Breast cancer patients interested in participating in the accelerated partial breast irradiation clinical trial may contact Dr. Gilbert Padula's office at 752-6218. For more information, go to http://www.mammosite.com.
"The benefit is that patients can resume their normal lives much sooner," Padula said.
Approved by the U.S. Food and Drug Administration, the new therapy is in ongoing clinical trials at The Lacks Cancer Center and other sites throughout the U.S. Although early results indicate both treatments are equally effective, the new approach is considered experimental until the trials provide definite proof. Typically, women diagnosed with small, early breast cancers may be eligible for the new therapy.
Those who choose to be part of the clinical trials are randomly assigned either the new or the traditional radiation treatment. To ensure receiving the new therapy, women also can choose to have it without being part of the clinical trials, and most health insurance companies will cover the cost.
Breast cancer options
Late last fall, Liz (who asked that her last name not be used), 47, of Lowell, underwent a breast-saving lumpectomy to remove a tumor and a small amount of surrounding tissue. When she consulted with her medical team through Breast Services at The Lacks Cancer Center, she was offered the option of being treated with the new procedure. Liz was sure APBI was right for her.
"The thought of coming in once a day for such a long period of time just wasn't something I wanted to do," she says. "I wanted to be done with my treatments as soon as I could to help get my life back to normal as soon as possible."
The therapy involves a small incision in the breast. A deflated balloon attached to a thin catheter is inserted in the breast into the space left by the lumpectomy.
Inflated with a saline solution, the balloon is secured inside the breast, while a portion of the catheter remains outside. The balloon can be placed during surgery or during a separate procedure up to several weeks later, and remains inserted for the duration of the therapy.
Using a CAT scan of the balloon, Liz's radiologist determined the dose of radiation to administer.
During the treatment, a catheter was connected to a computer-controlled machine and a tiny, radioactive seed was sent from the machine into the inflated balloon inside the breast.
Each treatment was between 5 and 10 minutes while the seed remained inside the balloon, delivering a concentrated dose of radiation.
At the end of the procedure, the seed was drawn back into the machine, and the catheter disconnected. The treatment was repeated twice daily during a 5-day period, and no radiation remained in the breast between treatments.
"It's not a painful procedure at all," Padula said.
Once all radiation sessions are completed, the balloon is deflated and removed with the catheter tube.
Few side effects
Although side effects can include redness, bruising and possibly some breast pain, Liz experienced none of these.
"I never had one bit of a problem," she said. "I would recommend this procedure to anyone."
"The current trend in treating breast cancer is breast conserving therapy," said breast surgeon, Dr. Jamie Caughran. "We want to save as much of the breast as we possibly can, yet still remove the tumor and margin area, while leaving the breast pretty much the same as it was."
"We're moving into a whole new world of treatments for breast cancer with more targeted therapy," Padula said. "In the future, every woman will have more options for personalized care."