Brachytherapy and IORT procedures?


Question from Katie JM: What about brachytherapy and IORT (intraoperative radiation therapy) procedures?
Answers - Lydia Komarnicky, M.D. Brachytherapy, also known as radiation implant therapy, has been around for many, many years. In the early 1900s, brachytherapy was actually the main mode of treatment for breast cancer, because we did not have the wonderful equipment we have today. So the concept is not new.

It started back in the 1900s with radium needles and has progressed to other forms of radiation materials. Now, there is a special technique called high-dose rate radiation, which is a form of brachytherapy. Potentially, all the radiation treatments can be given in one week through this brachytherapy implant.

There are different ways to do the brachytherapy implant. The most advertised way these days that you hear about is MammoSite. In this method, a catheter with a balloon on the end is placed in the cavity where the tumor was located and a small radioactive wire is placed in the balloon. This then retracts out of the balloon. It is done twice per day, as an outpatient, for five days.

The results are still early, but very promising. The recurrence rates appear to be very low. There should be strict criteria for the types of patients accepted for this type of therapy. Acceptable types are those with small tumors, patients with negative lymph nodes, and older women.
Marisa Weiss, M.D. In addition, this study, so far, only accepts women with non-lobular cell types and with negative margins of resection. The information available so far is really only in women with invasive breast cancer. Studies are just getting started looking at the use of partial breast radiation in women with DCIS, or non-invasive breast cancer.
Lydia Komarnicky, M.D. The results are very promising. The cosmetic results are looking quite good along with the low recurrence rates. This may become the wave of the future, but we're still obtaining data from the studies.
Marisa Weiss, M.D. The side effects of partial breast irradiation are less, because only a part of the breast is treated. Still, at this time, the standard of care is still whole breast radiation after the cancer has been completely removed. Later this year, a new study will open that compares whole breast radiation to partial breast irradiation in women with early-stage breast cancer.
Lydia Komarnicky, M.D. Another type of partial breast radiation is where small tubes are actually placed into the breast instead of the balloon. So there are other techniques available for partial breast irradiation rather than MammoSite.

Intraoperative radiation (IORT) is a technique not so much used for breast cancer, but for other types of malignancies, like pancreatic cancer or even recurrent rectal cancer.
Marisa Weiss, M.D. At the past San Antonio meeting, early results were presented on the possible role of intraoperative radiation as the technique to deliver full partial breast irradiation. The results are too early to base treatment decisions on at this time.

On Wednesday, March 17, 2004, our Ask-the-Expert Online Conference was called Radiation Therapy UpdatesLydia T. Komarnicky, M.D. and Marisa Weiss, M.D. answered your questions about advances in radiation therapy: the newest and best techniques, combining radiation therapy with other treatments, ways to manage, reduce or eliminate side effects, and more.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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