Women diagnosed with early-stage breast cancer who have lumpectomy to remove the cancer usually have radiation therapy after surgery. Radiation therapy after lumpectomy lowers the risk of the cancer coming back (recurrence) and makes lumpectomy as effective as mastectomy.
Radiation can be delivered to the entire breast -- called whole breast radiation -- or to just the area of the breast where the cancer was -- called accelerated partial breast radiation.
Traditional external beam radiation therapy aims cancer-destroying energy at the whole breast or to the area of the breast where the cancer was. The source of the radiation is outside the breast, which is why it's called "external beam." Many studies have shown the long- and short-term effectiveness of external beam radiation therapy. The drawbacks of traditional radiation therapy include daily trips to the hospital for treatments -- typically 5 days a week for 4 to 6 weeks. Traditional radiation therapy also has a large field and may expose healthy tissue, such as the heart and lungs, to radiation.
To overcome the drawbacks of traditional external beam radiation therapy, doctors have developed different ways to deliver radiation. Accelerated partial breast irradiation delivers a higher dose of radiation to a smaller area of the breast over a shorter period of time compared to traditional external beam radiation therapy. There are three types of accelerated partial-breast irradiation:
- Multi-catheter internal radiation, also called interstitial needle-catheter brachytherapy. This approach uses radioactive "seeds" to deliver radiation directly to the area where the cancer was. The seeds are placed in very small tubes (catheters) that are stitched into place under the skin. The seeds are left in the tubes for a few hours or a few days. You remain in the hospital during treatment. Once the treatment is completed, the seeds, tubes, and stitches are removed and you go home.
- Balloon internal radiation, known by the brand name MammoSite. This approach places a special tube with a balloon on one end in the breast where the cancer was. The tube comes out of the skin through a small hole. The tube and balloon are placed either during lumpectomy or afterward in a surgeon's office. During each treatment, a machine places a radioactive seed into the center of the balloon for 5 to 10 minutes -- just long enough to deliver the required dose of radiation. After the seed is removed, you may leave the treatment center. A total of 10 treatments are usually given over 5 days. That means two treatments per day, about 6 hours apart. When the final treatment is done, the balloon and tube are removed through the small hole in the skin.
- 3-D conformal external beam radiation (3DCRT). This experimental approach starts with a planning session (simulation). A special MRI or CAT scan of the breast is done and is used to map out small treatment fields for the area at risk. The type and distribution of radiation is designed to maximize the dose to the area that needs to be treated and avoid or minimize radiation to tissue near the area. The radiation is delivered with a linear accelerator, the same machine used in traditional external radiation, twice a day for 1 week.
A study suggests that for women diagnosed with early-stage breast cancer with a low risk of recurrence, brachytherapy seems to offer the same cosmetic results as whole-breast radiation after lumpectomy and causes fewer late side effects.
The research was published online on Jan. 13, 2017 by The Lancet Oncology. Read the abstract of “Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: 5-year results of a randomised, controlled, phase 3 trial.”
Late side effects are side effects that last well past the time radiation treatment is completed. In some cases, the side effects may not develop until after the treatment is finished. Late side effects of radiation therapy include:
- the skin in the treated area looks darker
- the skin in the treated area may feel different to the touch
- the hair on the skin in the treated area may grow back a different color or texture, or may not grow back at all
- developing red spidery marks on your skin (called telangiectasia) that are caused by small broken blood vessels
- the breast feeling firmer
The study was done at 16 cancer centers in Europe and included 1,328 women age 40 or older who had been diagnosed with stage 0 to stage IIA breast cancer. The women all had lumpectomy and were scheduled to have radiation after surgery.
Between April 20, 2004 and July 30, 2009, the researchers randomly assigned the women to receive one of two types of radiation:
- whole-breast radiation (673 women)
- accelerated partial breast irradiation with interstitial brachytherapy (655 women)
After 5 years of follow-up:
- 27.0% of women treated with whole-breast radiation had moderate to severe late side effects
- 23.3% of women treated with brachytherapy had moderate to severe late side effects
- 10.7% of women treated with whole breast radiation had moderate late side effects related to their skin
- 6.9% of women treated with brachytherapy had moderate late side effects related to their skin
- 11.9% of women treated with whole breast radiation had moderate breast pain
- 8.4% of women treated with brachytherapy had moderate breast pain
- 91% of women treated with whole breast radiation said they had excellent to good cosmetic results
- 93% of women treated with brachytherapy said they had excellent to good cosmetic results
So, overall, the women had similar cosmetic outcomes and experienced similar rates of late side effects. Women treated with brachytherapy had statistically significantly fewer moderate late skin side effects. This means that the difference in late skin side effects rates was likely due to the difference in radiation treatment and not just because of chance.
If you’ve been diagnosed with early-stage breast cancer with a low risk of recurrence and will be having lumpectomy and will be receiving radiation therapy after surgery, you and your doctor may be considering brachytherapy as an alternative to traditional external beam radiation therapy. Perhaps the daily trips to the treatment center would be a burden because of distance. Talk to your doctors about their experience with brachytherapy compared to traditional radiation therapy. You also may want to ask about their familiarity with the technical aspects of delivering brachytherapy since placement of the tubes is a skill that can take some time to master.
The Breastcancer.org Radiation Therapy section has more information on both traditional external beam radiation therapy and brachytherapy.
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