Questions for your Breast Surgeon and Radiation Oncologist:
- Am I a candidate for brachytherapy after my lumpectomy?
- If it is an option, would you recommend it for me?
- Do you offer brachytherapy?
- What are the outcomes compared to whole breast radiation?
- What are the side effects and complications of brachytherapy?
What is Brachytherapy?
Brachytherapy, a type of Accelerated Partial Breast Irradiation (APBI), is a technique of delivering a more focused radiation dose to the area of a lumpectomy over a shorter time period (one week) compared to whole breast radiation (four to six weeks). This one week course of radiation applied just to the inside edges of the lumpectomy cavity treats the areas of the breast that has the highest chance of having residual cancer cells. The goal is to reduce the chance of a “local recurrence.” Less than half of early-stage breast cancer patients meet the criteria for brachytherapy. Well-selected candidates may choose this option rather than standard whole breast radiation.
Brachytherapy does require an outpatient procedure to place a “brachytherapy catheter device” into the breast. This device usually has a small catheter that exits the breast and is cared for by the patient for about 7 to 10 days.
Who qualifies for brachytherapy radiation?
Brachytherapy is an option for patients who undergo a lumpectomy for early-stage cancer who have a number of favorable tumor characteristics. These include a small tumor, favorable receptors, no evidence of cancer in the lymph nodes, and generally women 50 years old and older. Ask your surgeon or radiation oncologist if you meet the specific guidelines they follow in selecting patients for brachytherapy. Not all breast surgeons and radiation facilities offer brachytherapy.
Brachytherapy radiation zones within the breast.
Why does radiation reduce “local recurrence” of cancer?
Radiation therapy is very effective at killing cancer cells while sparing the normal surrounding tissue. It is generally performed after surgery has removed your breast tumor. This treatment is one component of a comprehensive treatment plan by your breast cancer team. If you are going to have a lumpectomy surgery to remove your breast cancer, then you will most likely need radiation to reduce the chance cancer will grow back in the surgical area.
Quite simply, radiation reduces the chance of cancer growing back in the area where the tumor was surgically removed or in nearby areas where the cancer is at risk for recurring in the future. When a “local recurrence” of your cancer does occur, it can be a threat to your life. Radiation reduces this risk of local recurrence, and as a result, may increase your chances at a cancer-free future.
Is “Whole Breast Radiation” the gold standard?
Whole breast radiation involves radiating the entire breast without placing a device inside the breast. It is well tolerated. Most breast radiation is performed with this technique over a 4 to 6 week treatment period. Brachytherapy has been studied for decades, but we are still researching to see if the long term outcomes are as good as whole breast radiation. Modern brachytherapy techniques likely will prove to be very similar to whole breast radiation outcomes. Although it is now available in more communities, brachytherapy has its own set of advantages and complications. Take our video lesson on “What is Breast Radiation“ to learn more.
What are brachytherapy (APBI) treatment expectations?
Brachytherapy radiation is performed as an outpatient within a dedicated radiation center. It is very well tolerated. A few facts about brachytherapy or accelerated partial breast irradiation (APBI) are listed below.
Expectations during Brachytherapy
- Each treatment takes about 10 minutes
- Radiation does not hurt when administered
- Treatments are usually twice a day, Monday through Friday for one week
- The brachytherapy “catheter device” is removed immediately after your last treatment
Brachytherapy treatment summary
What are the side effects and toxicities of brachytherapy?
The field of radiation has dramatically reduced its side effects over the last decade. CT Scan Radiation Planning has revolutionized the ability to better focus radiation on the area of cancer and avoid damaging adjacent normal tissue.
Some side effects and toxicities
- Irritated and tender breast and skin
- Skin thickening and redness
- Soreness of the breast and ribs
- Cosmetic deformity
- Rarely, unusual cancers can be caused by breast radiation
Situations some choose brachytherapy?
If you cannot visit the radiation center daily for 4 to 6 weeks.
Many women do not live close enough to a radiation center to drive daily for 4 to 6 weeks of treatment. Those that live in rural areas may be attracted by a one week series of treatments. Lifestyle, work, and vacation plans can sometimes conflict with dedicating an uninterrupted 4 to 6 week period of daily trips to the radiation center.
If you want to avoid “whole breast radiation.”
Those very concerned about the side effects of whole breast radiation or who are considering forgoing radiation altogether may consider brachytherapy an attractive alternative.
This animation of the “SAVI” brachytherapy device shows how it is placed and outlines how the radiation treatment is administered with specialized catheters.
Cianna Medical manufactures the most commonly utilized brachytherapy device in the United States.
This link to their “Internal Breast Radiation” website page (here) outlines the different types of breast brachytherapy. This non-profit organization provides excellent patient resources about breast cancer.
This link (here) by the American Society of Breast Surgeons has an excellent description of “Partial Breast Radiation Therapy.” This site is created for patients by the American Society of Breast Surgeons.
This consensus statement (here) “Consensus Statement for Accelerated Partial Breast Irradiation” outlines the indications and clinical outcomes for breast brachytherapy. The American Society of Breast Surgeons is a leading organization of surgeons who treat diseases of the breast.
More Detailed References:
If you want to get deep into the details, this free 200-page pdf document (here) has guidelines to help clinicians to make treatment recommendations about nearly all aspects of breast cancer. You can easily register (here) as a non-professional to get access and more information about breast cancer. The National Comprehensive Cancer Network is the leading organization in developing clinical guidelines.