Subsequent Therapeutic Changes

Subsequent Therapeutic Changes:

Many subsequent variations have occurred. The first variation was to drop the brachytherapy and accomplish “the boost” with the linear accelerator using smaller radiation fields or another form of radiation available on the newer accelerators. This different radiation is the “Electron” boost. This is the most commonly used “boost” radiation done today.

This entire radiation process typically takes six to eight weeks. This delivers upwards of thirty to forty treatments. That’s a lot of visits to the radiation department.

In an attempt to shorten this long course of radiation, some surgeons and radiation therapists have begun to apply the previous “Needle” brachytherapy to the breast, as the only radiation. This is called “Boost Therapy” and this therapy does not use any EBRT. This can be done safely in:

small tumors (Ideally, less than 2 cm but up to 3 cm is acceptable)
non-aggressive tumors (well differentiated cancer are slower growing and less likely to spread early)
no metastasis (no cancer spread)
wide surgical lumpectomy margins and adequate spacing from the skin.
no Spread to regional Lymph Nodes, lymph nodes not involved with cancer, and
a breast cancer called Lobular Cancer is also excluded due to its peculiar tendency to have several scattered sites of cancer and not just the local tumor.
Age over 45

New Brachytherapy Device: Recently a new brachytherapy approach has been approved by the FDA and now accepted by all major insurance programs and Medicare. This new procedure is accomplished by having a plastic catheter with a saline or water filled bulb inserted into the cavity created by the surgeon as he or she removes the cancer. The catheter is then “loaded” with Iridium-192 to radiate the cavity and the immediate surrounding tissue. The trade name for the catheter is Mammosite, and made by a company called Proxima Therapeutics.

All Cancer Treatments are Potentially Dangerous: All of these changes are an understanding by cancer specialists that all cancer treatments are destructive. They therefore run the risk of complications, sometimes severe. We are therefore always exploring ways to modify, improve our treatments, and eliminate treatments where we can. Mammosite and Interstitial Brachytherapy appear to be a wonderful new addition to this drive to decrease and modify our radiation in selected patients.

Who is This Treatment for?
This treatment is not for everyone. In fact it may be for only a minor percentage of all breast cancer patients. The earlier qualifications would eliminate over half of all breast cancer patients. Some estimate this treatment will be acceptable for as few as one out of ten or as many as one out of three. Only time will tell.
It is also important to realize that this instrument treats only a portion of the breast surrounding the site of tumor removal. The standard radiation treats the whole breast. There is no way that Brachytherapy will control the whole breast as well as whole breast radiation. However, with careful screening and patient selection, we feel that the overall cure rates should be comparable and acceptable.
The tremendous advantage is the very short overall course of radiation: one week versus seven weeks.

Important Note: It is very important for all patients to realize that we have 30 plus years of experience with standard External Beam Radiation Therapy (EBRT). In this select group of ladies we have achieved a 93% cure rate (no evidence of disease at 12-15 years).
Only time and many patients treated will tell if Brachytherapy is as effective in curing patients as standard EBRT in this select group of patients. Each patient who picks this procedure must understand this and be willing to accept a potential difference in cure rate.
Obviously, we believe this treatment will be very close to EBRT, or we would not morally be able to offer this treatment as an alternative. The Cancer Center of Irvine is comfortable offering this treatment. We however would request all our patients, allow us to gather data on them, to further the body of knowledge needed to prove its effectiveness.