A choice for women: Breast Brachytherapy
5 Days Versus 6 1/2 Weeks of Radiation Treatment for Breast Cancer

The Center for Radiation Oncology is pleased to introduce a new procedure, one that affords some patients a choice of radiation treatment for breast cancer. It is well known that in most early stages of breast cancer, radiation therapy after a lumpectomy is as effective as a modified radical mastectomy. The standard option for radiation therapy to the breast is external beam radiation, where the radiation is delivered to the entire breast from a linear accelerator, followed by a boost to the lumpectomy site. The treatment to the breast is for 25-28 treatments over 5 1/2 weeks; the boost is for 6-9 treatments over one week, for a total of approximately 6 1/2 weeks of treatment. In addition to the more conventional external beam radiation, the Center for Radiation Oncology is now offering breast brachytherapy, high dose radiation to the lumpectomy site, that shortens the treatment time to one (1) week.

Although the experience with breast brachytherapy is not as extensive as external beam radiation, it has become an acceptable alternative to external beam radiation therapy in selected patients. Recent articles in Time Magazine (February 9, 2002) and The Tampa Tribune (February 5, 2002) discuss the newer treatments of breast cancer, such as breast brachytherapy. Unlike external beam radiation, breast brachytherapy is given with high dose rate (HDR) radiation that treats the lumpectomy site from the inside out in a short period of time. The entire breast is not treated, only the area of highest risk, or the lumpectomy site, and some surrounding normal breast tissue. The rationale is that most recurrences after a lumpectomy with or without radiation occur at or near the lumpectomy site; less than 5% occur at "elsewhere" sites in the breast. In other words, over 90% of recurrences occur in the original tumor bed.

Only selected patients are candidates for breast brachytherapy. Our team has attended an intensive workshop where three major universities presented their data and techniques. Their cumulative experience includes a 10-year follow-up of over 600 patients. The results are essentially the same as external beam radiation when comparing survival, disease free survival, local recurrence, and cosmetic results.

Done as an outpatient procedure, under CT guidance and local anesthesia (the patient is well sedated), needles are meticulously placed around the lumpectomy site, and are replaced by plastic catheters for the actual treatment. The radiation treatment is given through these catheters twice a day for 5 days; each treatment lasts 10 to 15 minutes. The catheters are removed after the final radiation treatment has been given. The procedure is well tolerated. The most obvious advantage is that the treatment time is one week, as compared to 6 1/2 weeks with external beam radiation. In addition, the treatment does not affect the entire breast, the lungs, the ribs or the heart (in the case of left breast cancer).

Candidates for breast brachytherapy must fit the following criteria:

• Invasive ductal cancers less than 3 cm
• Limited DCIS
• Selected lobular carcinoma, with or without lobular carcinoma in situ
• Node negative patients, although consideration will be given for 1 - 3 positive lymph nodes

Possible side effects from the procedure include cellulitis, firmness around the lumpectomy site, fat necrosis, scarring around the needle sites. Fortunately, the radiation technique has been well developed, and we are able to learn from the experience of the three universities. The above side effects appear to be rare.

Almost all patients are candidates for external beam radiation. However, not all patients are candidates for breast brachytherapy and need to be screened by our team, which includes an extensive evaluation as well as teaching by our nurses. If the patient is a candidate for the procedure, then the decision is a personal preference, taking into account the risks and benefits of both treatment approaches. We feel strongly that a woman should be given a choice of radiation treatment, when possible, following a lumpectomy.

Dr. Kepes is available to see breast cancer patients in consultation. If you are interested in breast brachytherapy and would like to see if you meet the selection criteria or if you are interested in more information, please contact Dr. Kepes or her clinical coordinator, Maria Appel RN at the Brandon office (813-661-6339).

Dr. Kepes is also available to speak to community groups as well as area physicians on radiation therapy for breast cancer.