Brachytherapy for Breast Cancer Treatment

Salitha Reddy, M.D.: Welcome to this mornings chat. I am Dr. Reddy, radiation oncologist with Rush-Copley. Today's topic is brachytherapy for breast cancer. What questions can I answer for you?
Melissa: What exactly is brachytherapy?
Salitha Reddy, M.D.: Brachytherapy literally means delivering treatment at close distance. In radiation therapy it means inserting a radioactive source at the treatment site or site of interest and delivers the necessary radiation. Most commonly recognized term for brachytherapy is an implant.
Diane: Who is a good canidate for this treatment?
Salitha Reddy, M.D.: Patients with small breast cancers with negative margins after a lumpectomy, with negative nodes are good candidates. Age can be a factor too.
Emily: What are the advantages of Brachytherapy in comparison to other treatments?
Salitha Reddy, M.D.: In patients with breast cancer after selecting them appropriately for brachytherapy the advantages are as the treatment is given to a portion of the breast only there are less side effects compared to the whole breast external beam radiation. Also the treatment is done twice a day and is completed in a week compared to five and a half to seven weeks of external beam.
Rose: Is this treatment only for breast cancer?
Rose: Brachytherapy/implant is done for other maliginancies like prostate cancer, gynecologic cancer, head and neck cancers etc.
Emily: Are there any side effects?
Salitha Reddy, M.D.: Yes. There is a slightly increased chance of infection at the surgical site. There can be scar tissue around the lumpectomy site which may cause thickening and sometimes a breakdown of the skin but this is rare.
Melissa: How new is the treatment?
Salitha Reddy, M.D.: It is relatively new compared to the external beam radiation. There has been enough patients treated within the last year and a half to two years with this technique. The results have been good but still it is not the standard technique. There is a national study that is underway testing this method against external beam radiation.
Rose: How effective is this treatment? Do you only do this treatment or in combination with chemo?
Salitha Reddy, M.D.: With the information we have so far it seems very effective and comparable to external beam radiation, if selected appropriately. If the patient needs chemo it can be done after completion of this treatment.
Diane: Does this require hospilization?
Salitha Reddy, M.D.: No. This is an outpatient procedure.
Melissa: How long do you undergo treatment?
Salitha Reddy, M.D.: The treatment is done twice a day, six hours a part for five days.
Melissa: How safe is it?
Salitha Reddy, M.D.: This treatment is very safe. When the patient leaves the department there is no concern for radiation.
Jane: Are there advantages of brachytherapy over traditional radiation therapy?
Salitha Reddy, M.D.: Yes because we treat only a portion of the breast the side effects are lower than whole breast radiation with external beam. External beam radiation is given as an outpatient five days a week for about six to seven weeks and as already stated the whole breast is treated. The other advantage for brachytherapy the treatment is done in a week.
Jane: Is the patient radioactive during treatment?
Salitha Reddy, M.D.: The patient is placed in the treatment room and set up for radiation. The staff comes out of the treatment room, radiation is given for a few minutes when the patient is by herself in the treatment room. After the treatment is done the radiation source is removed and the patient goes home and is not radioactive.
Jane: How does brachytherapy differ from traditional radiation therapy?
Salitha Reddy, M.D.: Traditional radiation for breast cancer patients has been done using external beam radiation that is given five days a week for about 5-7 weeks to the entire breast where as with brachytherapy radiation is delivered still as an outpatient but in a week to a portion of the breast. That is why it is also called partial breast radiation.
Jane: How long is the recovery time after the procedure?
Salitha Reddy, M.D.: The radiation should not add to the recovery time after lumpectomy and lymph node sampling.
Melissa: How soon after a lumpectomy will the brachytherapy begin?
Salitha Reddy, M.D.: About 5-7 days. At times if the lumpectomy cavity is larger than ideal we may wait another five days.
Emily: The treatment is done twice a day... but about how long does each treatment take?
Salitha Reddy, M.D.: The actual treatment is about seven to ten minutes. But the patient might have to be in the department for about an hour for the planning and the set-up.
Jane: Where and how are the seeds are implanted?
Salitha Reddy, M.D.: At the time of the lumpectomy, the surgeon inserts the mammo site balloon with a tube at the lumpectomy site. When the patient comes for radiation treatment the radiation source is inserted through the tube into the balloon. One end of the tube sticks out of the patient like a drain.
Jane: Does brachytherapy have the same long-term results as traditional radiation therapy?
Salitha Reddy, M.D.: We believe so but we don't have very long term results. That is why a national study is ongoing.
Salitha Reddy, M.D.: Women diagnosed with breast cancer should be evaluated for breast conservation which is in appropriate patients an alternative to mastectomy. This involves lumpectomy and radiation therapy. Conventionally we have been using external beam radiation to treat the entire breast and boost the biopsy cavity. Brachytherapy is a newer technique that is used as an alternative to external beam radiation. Patients have to be selected carefully and appropriately. It has advantages of lower side effects and shorter treatment times.
Jane: Will breast cancer brachytherapy effect my heart?
Salitha Reddy, M.D.: Even if the tumor is on the left side because with brachytherapy radiation dose falls off (decreases rapidly) there should be no radiation given to the heart for all practical purposes.
Jane: Where can I receive breast cancer brachytherapy?
Salitha Reddy, M.D.: Rush-Copley Medical Center.
Salitha Reddy, M.D.: Thank you for joining me for today's chat. For more information about brachytherapy (also known as HDR brachytherapy) please visit the Rush-Copley website at www.rushcopley.com under cancer services.