Interstitial Brachytherapy For Early-Stage Breast Cancer

Her compassion is just what the doctor ordered
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If your doctor has recommended interstitial brachytherapy for after your lumpectomy you may wonder what this is and what you can expect during treatment.  How does this differ from whole breast radiation?  Is there a difference in survival or the cosmetic result with this approach?  What can you expect before, during, and after treatment?

Treating Breast Cancer At Its Source

Treating breast cancer with external beam radiation is a well-tested method of treatment that can help prevent recurrence, but also affects breast skin, texture, color, and may eventually cause a change in the shape of your breast.

Interstitial brachytherapy - which treats breast tissue from inside your breast - doesn't affect your skin, limits radiation to healthy breast tissue, and leaves your breast shape unchanged after a lumpectomy. But the most appealing aspect of breast brachytherapy may be that it can be done in 5 days, instead of the 6 to 7 weeks needed for standard external beam radiation.

Recent studies continue to find that the cosmetic result with interstitial brachytherapy is excellent, and it does not appear to be inferior to whole breast radiation in terms of 5-year control of breast cancer, disease-free survival, or in overall survival.

Interstitial Brachytherapy Is Also Known As:

interstitial multicatheter brachytherapy, implant radiation therapy, internal radiation therapy, and radiation brachytherapy.

Preparing For Interstitial Breast Brachytherapy Treatment:

Interstitial brachytherapy can treat a larger area of breast tissue than intracavity.

Multiple brachytherapy catheters can be positioned around the tumor cavity, either during your lumpectomy or a month after surgery. Your doctor will carefully study your treatment needs, plan the best catheter positions and determine the amount of radiation that will work for you. When the catheters are placed, your surgeon will be guided by imaging technology such as CAT scan, ultrasound, or fluoroscope.

You can be sure that the radiation will be aimed at the place where cancer cells are most likely to be hiding.

What To Expect During Brachytherapy Treatment:

Interstitial breast brachytherapy is done through soft, slender tubes - called catheters - that are strategically placed into your breast tissue. The catheters can be opened at one end during treatment, so radioactive seeds can be threaded into your breast tissue for treatment. Since you may have between 10 and 20 catheters, the seeds can be positioned all around your lumpectomy cavity. As soon as the proper radiation dose has been given, all the seeds are removed and the catheters are closed again. You won't carry the radioactive seeds inside you between treatments.

Taking Care Of Yourself During Breast Radiation:

You may have some mild side effects during breast brachytherapy. Watch out for fatigue, breast soreness, or swelling. Wearing a soft, wire-free bra (or going braless) will make it easier for you to accommodate the catheters.

You will be able to drive yourself to the twice-daily radiation appointments, but if you feel better with company, take a supportive friend along.

After Completing Interstitial Brachytherapy Treatments:

Once you have finished treatment, the catheters will be removed and you will begin to heal. Have a mammogram at 4-6 months after radiation for a new baseline. About the same time, schedule a clinical breast exam to check on cosmetic appearance, recurrence, and any complications from the radiation treatments. While you're there, tell your doctor about any concerns you have about recurrence after breast brachytherapy. If any dense areas show up on your mammogram, don't panic right away. Having a breast biopsy can sort out a recurrence from an area of breast fat necrosis.

Recovery From Interstitial Brachytherapy:

You can expect recovery from interstitial breast brachytherapy to be gradual, and full recovery may take about two years for most patients.  If an infection related to the radiation treatment occurs, it will usually happen during the first month after treatment is finished.  It is normal to have some breast pain and swelling - but that should fade over time.  Your breast may feel firmer after radiation, as some fatty tissues may die.  In rare cases, breast skin may develop some ruddy blotches due to dilated blood vessels.  Let your doctor know if any lingering after-effects of radiation cause you concern.

No Smoking, Please!:

Smoking before, during, or after radiation treatment is a bad idea. Smoking can result in greater risk of infection and can cause fluid buildup and drainage. Healing can be delayed by smoking - wounds where the catheters were inserted won't close as quickly. Smoking can also cause scabs or dead skin to form around the catheter insertion scars, which may have to be removed by enzyme treatments or surgery. Smoking also raises your risk of breast cancer, so please get help to quit smoking. Your health is worth the effort!

Sources:

Kamrava, M. et al. Outcomes of Breast Cancer Patients Treated with Accelerated Partial Breast Irradiation Via MulticatheterInterstitial Brachytherapy: The Pooled Registry of Multicatheter Interstitial Sites (PROMIS) Experience. Annals of Surgical Oncology. 2015. 22 Suppl 3:404-11.

Strnad, V. et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet. 2015 Oct 19. (Epub ahead of print).

Wobb, J. et al. Comparison of chronic toxicities between brachytherapy-based accelerated partial breast irradiation and wholebreast irradiation using intensity modulated radiotherapy. Breast. 10`5. 24(6):739-44.

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