What Is Brachytherapy For Breast Cancer

Brachytherapy Treatment For Breast Cancer

Brachytherapy refers to radiation therapy that involves placing radioactive material directly into or adjacent to the tumor, rather than through external beams. Today, brachytherapy is a standard technique in the treatment of a large number of malignancies and often used in combination with EBRT. Brachytherapy treatments use radioactive materials such as cesium-137, iridium-192, palladium-103, or iodine-125. Radioactive sources that deliver radiation at a high dose rate such as iridium-192 are referred to as HDR . Through the use of brachytherapy, the radioactive source can be placed next to or directly into the tumor. Because the energy of the radioactive source is low, a high energy is delivered to the tumor, with nearby normal surrounding tissues receiving very little dose. Brachytherapy can be administered using a multitude of techniques- all dependent on the tumor being treated.

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Intensity Modulated Radiation Therapy

Advanced software is used to plan a precise dose of radiation to the area where a tumor was removed. A computer-controlled device called a linear accelerator delivers radiation in sculpted doses that match the 3D geometrical shape of the target, including concave and complex shapes.

Advantages of IMRT for breast cancer may include:

• IMRT employs an advanced computer program to map your radiation dosage in three dimensions.
• IMRT directs radiation at the target and modulates the intensity of the radiation beams, helping to spare healthy tissue.

IMRT breast cancer radiation therapy may be used in conjunction with other treatments. It may be an appropriate option for those who have previously had breast cancer radiation therapy and are experiencing recurrent tumors in the treated area.

How Long Does The Brachytherapy Radiation Stay In The Body

After treatment, your body may give off a small amount of radiation for a short time. If the radiation is contained in a temporary implant, youll be asked to stay in the hospital and may have to limit your interactions with visitors. Pregnant women and children may not be allowed to visit you. Once the implant is removed, your body will no longer give off radiation.

Permanent implants give off small doses of radiation over a few weeks to months as they slowly stop giving off radiation. The radiation doesnt usually travel far, so the chance that others could be exposed to radiation is very small. Still, you may be asked to take precautions such as staying away from small children and pregnant women, especially right after treatment.

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A Type Of Radiation Therapy That Treats Cancer At Its Source

Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.

• Contraindications

Brachytherapy is a type of cancer treatment, also called internal radiation therapy, that involves placing a sealed radioactive source in or near a tumor to destroy the cancer cells. It is used to treat many different types of cancer but can be used in breast cancer to kill cancer cells after a lumpectomy. Brachytherapy may also be used to reduce the size of a tumor before breast cancer surgery or as palliative treatment to reduce pain or bleeding in advanced or inoperable disease.

Brachytherapy is used to treat early-stage breast cancers that have not spread to other parts of the body. The treatment can be delivered in different ways and is often combined with conventional external beam radiation therapy .

In this article, we will review what brachytherapy is, how it is given, and any potential side effects that may occur.

Despite strict selection criteria, an estimated 71,000 American women would benefit from breast brachytherapy each year, according to a 2017 review of studies in the Journal of Contemporary Brachytherapy.

Brachytherapy To The Cervix Womb Or Vagina

You might have brachytherapy for cancer of the cervix, womb or vagina.

Your doctor puts hollow tubes into the vagina to the area where the cancer is, under general anaesthetic. They attach the tubes to a brachytherapy machine. The radioactive source moves from the machine through the tubes to the cancer.

The radioactive source may stay inside your body for about 10 to 20 minutes. After the treatment, the source moves back into the machine. You may have several treatments. You have this treatment as an inpatient or outpatient.

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What Should I Expect Before Radiation Therapy For Breast Cancer

Most people who have breast cancer treatment receive external beam radiation therapy. The goal is to destroy any remaining cancerous cells while protecting healthy tissue.

Before your first treatment, you will have a planning session . This simulation helps your provider map out the treatment area while sparing normal tissues . This session may take one hour or longer.

During the simulation, your provider:

Possible Side Effects Of External Beam Radiation

The main short-term side effects of external beam radiation therapy to the breast are:

• Swelling in the breast
• Skin changes in the treated area similar to a sunburn
• Fatigue

Your health care team may advise you to avoid exposing the treated skin to the sun because it could make the skin changes worse. Most skin changes get better within a few months. Changes to the breast tissue usually go away in 6 to 12 months, but it can take longer.

External beam radiation therapy can also cause side effects later on:

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High Dose Rate Brachytherapy

With high dose rate brachytherapy, the radioactive source is put in your body for several minutes. The radioactive source travels from the brachytherapy machine through hollow tubes or needles to get to the right position. You may have the applicators put in while under general anaesthetic.

After 5 to 20 minutes of treatment, the source travels back along the applicators to the brachytherapy machine and you are no longer radioactive.

You might have:

• several treatments over a number of days

Sometimes you have two treatments on one day.

The applicators might be put in before each treatment session, or stay in place until after your final treatment. Your treatment team will give you information about what to expect before treatment starts.

Application Of Catheters After Bcs

Applicators are often implanted after healing of the surgical scar and after receiving the final histopathological diagnosis in 2-4 weeks after surgery. The radiation oncologist inserts applicators after visualization of the tumor bed using the X-ray and using ultrasound, in general or local anesthesia . Location of applicators on the skin with subcutaneous tissue and part of the breast is anesthetized with a solution of lidocaine or Xylocaine , while analgesics are administered intravenously. General anesthesia involves standard procedures. After determining the shape and position of the tumor bed, a correct template is selected, the number of planes, the distance between the applicators and the active length for stepping source is proposed. The number of implanted applicators has to be determined individually, depending on breast size, location of the tumor bed, and type of surgery . Frequently there are from 7 to over a dozen applicators. shows images of applicators implanted in a patient with breast cancer after quadrantectomy, covering the upper external quadrant. and present examples of treatment plans and applicators used in interstitial BT.

The distribution of dose obtained after the preparation of the treatment plan, target CT cross-sections performed every 2-3 mm

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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. Learn more about Breast Cancer Recurrence with our video lesson .

While The Catheter Is In Place

Your doctor or nurse will give you a surgical bra or a prescription for one. Wear the bra at all times, even while sleeping. It is for support and comfort, and it protects the catheter. You may do your normal daily activities as you feel able. Your doctor may prescribe pain medicine to take as needed. He or she also may prescribe an antibiotic. If you are prescribed antibiotics, take them as directed until you have finished them.

Other precautions:

• Do not shower while the catheter is in place. You may sponge bathe and wash your hair over a sink.
• Avoid getting the treated breast wet.
• Avoid carrying or lifting anything with the arm on your affected side.

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Internal And External Radiation Therapy

Radiation therapy, in general, uses high-energy radiation to shrink tumors and kill cancer cells. Currently, two different types of radiation therapy are available to treat various types of cancer:

Savi Vs Other Forms Of Brachytherapy

The SAVI device is a proprietary system that received 510 clearance from the U.S. Food and Drug Administration in 2006. The classification is used for medical devices that are considered safe and “substantially equivalent” to similar devices in current use.

It is considered a viable alternative to balloon brachytherapy, which employs an inflatable balloon filled with radioactive pellets to deliver radiation from within.

As opposed to interstitial brachytherapy which involves the insertion of multiple tubes in and around a tumor, the SAVI system only requires a single entry point.

SAVI-based APBI, like other forms of brachytherapy, reduces many of the characteristics risks of external beam radiation. These include skin changes , hardening of breast tissue , spider veins , breast malformation, localized nerve damage , and damage to underlying bone and lung tissues.

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Side Effects Of Brachytherapy

Radiation therapy is generally associated with side effects. These side effects are well known and most side effects are not dependent on the type of radiation therapy. However, brachytherapy is associated with sparing the surrounding healthy tissue from unnecessary radiation with the potential for fewer side effects than alternatives such as external beam radiotherapy.1-2

People respond to treatments in different ways. Some side effects may appear in the short-term or may appear several months later .

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.

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What To Expect When The Catheter Is Removed

Once you finish treatment with LDR or HDR implants, the catheter will be removed. Here are some things to expect:

• You will get medicine for pain before the catheter or applicator is removed.
• The area where the catheter or applicator was might be tender for a few months.
• There is no radiation in your body after the catheter or applicator is removed. It is safe for people to be near you-even young children and pregnant women.

For a week or two, you may need to limit activities that take a lot of effort. Ask your doctor what kinds of activities are safe for you and which ones you should avoid.

What Is Hdr Brachytherapy

HDR brachytherapy is a type of radiation used as part of BCT. HDR brachytherapy delivers a high dose of radiation in and around the tumor. It spares much of the surrounding healthy tissue.

Brachytherapy may be used alone or with surgery, external beam radiation, and chemotherapy. It may cure, control, or relieve symptoms of many types of cancer.

Radiation is given for a set length of time by a small, radioactive source. The radiation dose and length of time depend on the tumor size and location.

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Side Effects Of Radiation Therapy For Breast Cancer

• Redness or discoloration of the skin
• Breast pain and/or swelling

Other long-term side effects of radiation for breast cancer include:

• Changes to the feel or size of the breast
• Difficulty breastfeeding
• Nerve damage that may lead to weakness, numbness or pain
• Damage to the lymph system resulting in lymphedema
• Bone weakness and fractures

How Is The Procedure Performed

Permanent brachytherapy:

Permanent brachytherapy inserts needles pre-filled with radioactive seeds into the tumor. The doctor will remove the needle and leave the seeds behind. Seeds may also be implanted using a device that inserts them individually at regular intervals. The procedure may use medical imaging to help position the seeds. The doctor may do more imaging tests later to verify seed placement.

Temporary brachytherapy:

Temporary brachytherapy places a delivery device, such as a catheter, needle, or applicator into the tumor. Medical imaging helps position the radiation sources. The doctor may insert the delivery device into a body cavity such as the vagina or uterus . Or, the doctor may insert an applicator into body tissues .

High dose-rate treatments deliver radiation over 10 to 20 minutes per session. Low dose-rate treatments deliver radiation over 20 to 50 hours. Pulsed dose-rate treatments deliver radiation in periodic pulses.

LDR treatment delivers radiation at a continuous rate over one to two days. It requires an overnight stay at the hospital. This allows the delivery device to remain in place throughout the treatment period. PDR treatment delivers radiation similarly using periodic pulses . The doctor may insert the material through the delivery device by hand and remove it later once treatment is complete.

Once treatment is complete, the doctor removes the delivery device from the patient.

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How Effective Is Radiation Therapy

If early-stage breast cancer hasnt spread, radiation therapy after a lumpectomy significantly reduces the risk of cancer coming back by approximately 50%. Studies show that a lumpectomy followed by radiation therapy is as effective as a mastectomy without radiation therapy.

People who undergo a lumpectomy have a 20% to 40% chance of the cancer coming back at 10 to 20 years. With the addition of postsurgical radiation therapy, that risk drops to 5% to 10%. However, there are some patients who derive less benefit from radiation including patients 65 years or older with small cancers.

How Will I Feel During Implant Therapy

Youre not likely to have a lot of pain or feel sick while implants are being put in. The drugs used while theyre being placed might make you feel drowsy, weak, or sick to your stomach, but these side effects dont last long. If your implant is held in place by an applicator, you may have some discomfort in that area. If you have the kind of implant where you need to be in bed for a few days, you may have aches and pains from being inactive. Ask for medicine to help you relax or to relieve pain if needed. Be sure to tell your cancer care team if you have burning, sweating, or other symptoms.

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Radiation Therapy For Breast Cancer

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. Breast cancer patients may receive one or a combination of radiation therapies that fit into two basic categories:

• External beam radiation therapy
• Accelerated partial breast irradiation

Radiation therapy is typically recommended for breast cancer patients after a tumor has been removed, to kill microscopic cancer cells that may have been left behind. Radiation therapy may also be used in combination with other therapies, such as chemotherapy or hormone therapy.

The length of radiation therapy treatment depends on a variety of factors, including the type of therapy used and the stage of the disease.

Rationale For The Use Of A Boost After Breast Conserving Surgery And Whole Breast Radiation Therapy

The goal of irradiation is to minimize the risk of a local relapse within the treated breast, especially in the area of a tumor bed which is a target volume for brachytherapy. There are many methods of increasing the dose to the tumor bed . The best approach is chosen depending on clinical and morphological criteria, patient’s will and institutional resources and protocols. Modern interstitial multi-catheter high-dose-rate brachytherapy offers conformal and accurate irradiation of the target volume, provided that there are surgical clips left in the operated breast and the treatment planning system is computed tomography based. Patient’s age of < 50 years close, microscopically positive or unknown surgical margins and the presence of an extensive intraductal component are accepted indications for boost irradiation . Randomized boost vs. no boost trials revealed that there is an evident benefit from administering an additional dose to the tumor bed. The boost reduces 5-year local recurrence rates from 7.3-13.3% to 3.6-6.3% . Polgár et al. also summarized the results of many different HDR brachytherapy series worldwide, in which in total 1776 patients, a 5-year local recurrence rate of 0-9% was achieved .

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