Breast Brachytherapy

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Breast Brachytherapy

( High Dose Rate Brachytherapy for Breast Cancer )

1. Introduction

Over the past two decades, breast conserving treatment, consisting of

lumpectomy and external beam radiotherapy, has become a standard treatment

option for

patients with early stage cancer. It has been demonstrated to offer similar

local control and survival results compared with mastectomy, while providing

acceptable cosmetic outcome, and less emotional trauma. However, the primary

disadvantages are 6 to 7 weeks of external beam treatment and potential side

effects to the adjacent organs such as the underlying lungs and scatter

radiation

dose to the opposite breast.

Recurrence rates followinglumpectomy and whole breast external beam

radiotherapy are approximately 10%. The majority of recurrences are in the

vicinity of

the lumpectomy site. The potential to reduce breast recurrence rates lies in

maximizing the radiation dose to the breast tissue surrounding the lumpectomy

site, which is the tissue most likely to harbor residual microscopic disease.

Attempts to increase the radiation dose using external beam radiotherapy have

resulted in increasing the side effects such as moderate to severe skin

reactions (desquamations), and excessive doses to the underlying ribs and lung.

The

best method of increasing the dose to the lumpectomy site while minimizing the

dose to the normal structures is HDR brachytherapy.

Table of Content

Introduction

Advantage of HDR Brachytherapy

Surgery and HDR Procedure

Computer Dosimetry

Cosmetic Result

Back to Top2. The Advantages of HDR Brachytherapy

The overall treatment time is reduced to 5 to 7 days compared to a 6 to 7

week course of external beam radiotherapy.

Breast brachytherapy delivers a precisely targeted dose to the tissues most

at risk for recurrence, increasing the likelihood of tumor control.

Reduces radiation dose to the lungs and opposite breast

Reduces radiation dose to the breast outside the brachytherapy treatment

volume, avoiding potential long term adverse cosmetic side effects associated

with

whole breast external beam therapy, such as fibrosis and skin reactions.

Breast brachytherapy causes no delays in other treatments such as

chemotherapy.

Conserve your breast and yield excellent cosmetic result .

3. Surgery and HDR Procedure

The brachytherapy implant can be done at the time of lumpectomy or later,

after the lumpectomy incision has healed. The patient is placed under general

anesthesia. The brachytherapy physician places rows of thin hollow tubes, the

treatment catheters, to encompass the tumor bed plus generous margins. These

catheters will later hold the radioactive source. The catheters are left in

place

with the catheter ends protruding through the skin for the duration of the

treatment course, which is about five days. On the first day of treatment,

radiographic or CT images of the implant are obtained for treatment planning

purposes. After the radiation dose plan is reviewed and approved by the

physician,

the treatments can begin.

Fig 1: Breast Implants

The protruding ends of the plastic catheters are connected via longer,

transfer tubes to the treatment unit, called the afterloader, that contains the

tiny radioactive source. The tiny (1mmx3mm) source is welded to the tip of a

flexible stainless steel cable that travels in and out of the treatment

catheters. The source steps through each of the catheters, stopping every 5mm to

deliver the required radiation dose. After the treatment is delivered, the

source

retracts into the afterloader, the treatment catheters are disconnected from

the transfer tubes, the nurses cover the implant with dressings and the patient

goes home. The time the source spends in the catheters is about 10 minutes.

The breast is treated twice a day for five days, for a total of 10 treatments

(also called " fractions " ). After the last treatment, the physician removes

the catheters. The catheters easily slip out of the breast with minimal

bleeding. Antibiotic ointment is applied to the catheter insertion sites. The

patient

is instructed on skin care and given an appointment to return for a follow-up

visit.

Back to Top4. Computer Dosimetry

Fig 2: 3D computer simulation showing radiation dose cloud.

The image on the left is the 3-D representation of the implant catheters

(light blue), the 100% radiation dose " cloud " (blue) the underlying lung

(yellow),

and the skin (transparent yellow). The image on the right is a transverse CT

cut showing the levels of radiation dose. Note how the dosimetrist has shaped

the treatment volume to avoid the underlying ribs and lung and keep the skin

dose at 50% of the prescription dose to avoid skin reactions.

5. Cosmetic Result

Fig 3: 2 months after treatment. Fig 4: 10 months after treatment.

Fig 5: 3 years after treatment, achieve excellent cosmetic result.

General Frequently Asked Questions

1. How does radiation kill cancer?

Cancer is made of abnormal cells that tend to grow without control. Cancer

DNA is more sensitive to radiation than are normal cells, so radiation kills

cancer directly or when the cells attempt to multiply while normal tissue in the

region is able to repair and recover.

2. What is Brachytherapy?

The prefix " brachy " is the Greek word for " short " distance. Brachytherapy is

a form of internal radiation treatment where radioactive sources are placed on

or into cancer tissues. There are two kinds of brachytherapy. The radiation

sources may be inserted either permanently or temporarily. The two most common

forms of treatment are low dose rate (LDR) permanent seeds for prostate cancer

and high dose rate (HDR) temporary brachytherapy, that can be used for

prostate, gynecologic, breast, head and neck, lung, esophageal, bile duct,

anorectal, sarcoma, and other cancers.

3. What is high dose rate (HDR) Brachytherapy?

High dose rate (HDR) is a technically advanced form of brachytherapy. A high

intensity radiation source is delivered with millimeter precision under

computer guidance directly into the tumor killing it from the inside out while

avoiding injury to surrounding normal healthy tissue. For a more in depth

explanation please go to understanding HDR Brachytherapy page.

4. What are the advantages of HDR Brachytherapy?

Preservation of organ structure and function

Improved accuracy and precision of radiation dose delivery

Knowledge of radiation dose distribution before treatment is given

Ability to shape the radiation dose to fit the tumor

Fewer side effects

No radiation source (seeds) migration into other organs

No radiation exposure to other persons

The treatment course is days rather than weeks to months (as required for

permanent seeds or external beam)

Excellent coverage of possible microscopic extension of cancer

Minimizes areas of radiation overdose (hot spots) or underdose (cold spots)

Organ motion (target movement) is not a problem for HDR as it is with

external beam

Effective treatment for cancer recurrence (termed " salvage " therapy) 5. How

successful is HDR Brachytherapy?

HDR Brachytherapy is proven to be effective for the treatment of local

disease in many forms of cancer including prostate, gynecological, breast, head

and

neck, esophagus, lung, anorectal, bile duct, sarcoma, and other primary cancer

or localized metastasis as reported in the medical literature. CET's

publication on prostate cancer, for example has demonstrated 90% 10-year tumor

control. Success rates for other tumors vary according to the type and stage of

cancer being treated.

6. How many treatments has CET administered?

As of 8/31/2005, CET has performed 8,023 HDR implants and delivered 16,464

HDR treatments. Please see our treatment statistics for further details.

7. Why is HDR less well known than other forms of cancer treatment?

HDR Brachytherapy is a relatively new form of advance radiation technology.

Fewer physicians have been trained to perform HDR procedures compared to seed

implants or external beam radiation. Few centers, other than CET have been

dedicated to the development of HDR brachytherapy to its full potential. Dr.

Demanes has devoted his career to the advancement of brachytherapy and has

pioneered the use of HDR and established CET as a center of excellence with

specially

trained and experienced staff and physicians.

8. Why should I select CET?

Most experienced HDR center in the country

First center specializing solely in HDR brachytherapy

Recognized as HDR experts by colleagues in radiation oncology

Acknowledged safety record

Highly trained and experienced physicians and staff

Long term results published in peer reviewed medical literature

Quality patient care and follow up Please see CET Advantage for more

information.

About Us

California Endocurietherapy Cancer Center (CET) is the first brachytherapy

only center in the United States.

Founded by D Demanes M.D. in 1981.

Dedicated solely to High Dose Rate brachytherapy (HDR) since 1991.

Most experienced HDR brachytherapy center.

A training destination for physicians and residents.

HDR treatment protocol development

Innovation in high dose rate brachytherapy and equipment design

Dedicated to long-term follow-up, outcome studies, and publications in

medical journals.

Membership and affiliations

American Society for Therapeutic Radiology And Oncology

Chair - Health Policy and Economics Practice Management Subcommittee,

Chair - Regulatory Subcommittee, Member - Health Policy and Economic

Committee,

Member - Health Policy and Economics Code Development and Valuation

Subcommittee,

Member - Code Utilization and Application Subcommittee.

American Brachytherapy Society

Chair - Socioeconomic Committee.

American College of Radiation Oncology

President - 2005 to 2006

CET Cancer Center

California Endocurietherapy Medical Corp.

3012 Summit St. Suite 2675, Oakland, CA 94609

Tel: 877-238-1437 or 510-986-0690 Fax: 510-986-0159

Hours: Mon-Fri, 8:30AM to 5:00PM Pacific Time

Copyright California Endocurietherapy Medical Corp. .

www.cetmc.com