MD
Anderson Cancer Center
Date:
March 2011
Narrator:
Radiation
therapy after breast cancer surgery is an important part of your
treatment. It has been found to lower
the risk of cancer returning in the breast.
Traditionally, radiation therapy is given from the outside to the whole
breast for 6 to 8 weeks. A shorter
alternative form of radiation therapy is Accelerated Partial Breast Irradiation
known as APBI. This treatment can take
as little as 5 days to complete.
Dr. Elizabeth Bloom:
APBI
uses brachytherapy which specifically places a
radiation source within or next to tissue at most risk for having cancer
cells. Normal, healthy tissues are
exposed to less radiation so patients typically experience fewer side effects.
Narrator:
This
type of therapy is given to breast cancer patients after lumpectomy
surgery. During a lumpectomy, a surgeon
removes your tumor and surrounding breast tissue. The space that is left after your tumor has
been removed is called the lumpectomy cavity.
A catheter or thin tube called a brachytherapy
device is inserted through the skin into the lumpectomy cavity. Radiation is
then delivered directly to the tissue surrounding the lumpectomy cavity where
cancer is most likely to return. Since
radiation is given from within the lumpectomy cavity, your normal healthy
tissues are exposed to less radiation. This lessens side effects such as skin
discoloration, fatigue, burning and damage to nearby organs. It is important though for women to
understand the research when deciding between traditional whole breast
radiation and APBI.
Dr. Elizabeth Bloom:
There's
20 years of research showing that with early stage breast cancer a lumpectomy,
followed by whole breast radiation, is as effective as a mastectomy in the
local treatment of the breast. Research
also shows that when cancer does return in the breast, it most often returns in
the tissues immediately surrounding the lumpectomy cavity. It only returns away from the lumpectomy
cavity 1 to 4 percent of the time. And
this is the same whether or not patients receive whole breast radiation.
In
other words whole breast radiation has not been shown to provide additional
protection against cancer developing or returning in other parts of the
breast. APBI targets the breast tissue
immediately surrounding the lumpectomy cavity which reduces the amount of
radiation to the rest of the breast.
Studies have shown that the rate of cancer returning within the breast
is in general less than 5 percent. But
there has only been 5 to 10 years of follow up data.
Brachytherapy
Catheter Placement
Narrator:
If
you are a candidate for brachytherapy, your doctor
will decide which brachytherapy device will work best
for you based on your breast size and the location, size and shape of your
lumpectomy cavity. There are two methods
of placing the brachytherapy device within your
breast, two-stage placement and one-stage placement. Your surgeon and radiation oncologist will
work together to plan your treatment and decide if two-stage or one-stage
placement is best for you.
With
two-stage placement, your surgeon places a temporary spacer within the
lumpectomy cavity during your breast surgery.
With one-stage placement, a temporary spacer is not placed during your
breast surgery. A few days after your
breast surgery, you will meet with the radiation oncologist. You will have a CT scan for the doctor to
assess your lumpectomy cavity and determine the best brachytherapy
device to use for treatment.
Next,
you will have your postoperative appointment with your surgeon. At that time your surgeon will place the brachytherapy device in your breast. If you had two-stage placement, the temporary
spacer is replaced with the appropriate brachytherapy
device. To do this, the skin of your
breast and your lumpectomy cavity will be numbed using a local anesthetic. The spacer is removed and the new device is
placed through the same entry into your lumpectomy cavity.
If
you had one-stage placement, there is no temporary spacer to remove. Your surgeon will numb the skin of your
breast and your lumpectomy cavity with a local anesthetic. A small incision will be made in the breast
to allow the appropriate brachytherapy device to go
through the opening into the lumpectomy cavity.
The
placement of the device is relatively painless for both methods because you are
given a local anesthetic and medicine the morning of your appointment to help
you relax. You will be awake and able to
talk during the procedure.
Brachytherapy
Treatment Plan
Narrator:
Once
the appropriate brachytherapy device is placed in
your breast, you will have a treatment planning appointment scheduled one to
three days later. During this
appointment, a CT will be performed to help your radiation oncologist plan your
treatment.
Brachytherapy
Treatment
Narrator:
Radiation
treatment begins the next day and is given twice a day, 6 hours or more apart
for 5 working days. During each
treatment the portion of the catheter that remains outside your breast is connected
to a machine. This machine puts a
radioactive pellet into the catheter.
The pellet travels down the catheter inside the lumpectomy cavity to
deliver radiation. Each treatment takes
about 10 to 20 minutes. When the
radiation treatment session is finished, the pellet is withdrawn back into the
machine and the catheter is disconnected.
No radiation remains inside your breast in between treatments. After all the treatment sessions are
complete, the brachytherapy device will be
removed.
If
you have any questions about Accelerated Partial Breast Irradiation please ask
your doctor or nurse.
© 2011 The University of Texas MD
Anderson Cancer Center
1515 Holcombe Blvd, Houston, TX 77030
1-800-392-1611 (USA) / 1-713-792-6161