Brachytherapy or Internal Radiation
Internal radiation, called brachytherapy by doctors, can be an option for certain women after lumpectomy. The size and location of the cancer may limit who is a good candidate for brachytherapy.
According to guidelines released by the American Brachytherapy Society, appropriate candidates for brachytherapy are women age 45 and older diagnosed with DCIS or early-stage invasive breast cancer removed by lumpectomy that:
is hormone-receptor-positive or hormone-receptor-negative
is 3 centimeters or smaller in size
is node-negative (no cancer was found in the lymph nodes)
is not in the lymphovascular system
has negative or clear margins, meaning no cancer cells were found in the rim of healthy tissue removed with the cancer
Brachytherapy is a way to deliver accelerated partial-breast radiation. Accelerated partial-breast radiation gives a larger dose of radiation over a shorter period of time to only the part of the breast where the cancer was, rather than the entire breast.
Brachytherapy methods typically use small pieces of radioactive material, called seeds, which are placed in the area around where the cancer was. The seeds emit radiation into the surrounding tissue. The area that's very close to the site of the original cancer is the area that is at highest risk of recurrence (the cancer coming back).
Brachytherapy is most commonly delivered using a number of small tubes or catheters (called multi-catheter brachytherapy) or with a balloon-catheter or other device (called balloon-catheter or applicator brachytherapy).
Multi-catheter brachytherapy: What to expect
Planning for multi-catheter brachytherapy involves meeting with your radiation oncologist and possibly having X-rays or other imaging done to plan exactly where the radiation will be delivered.
After the planning is complete, a member of your radiation team will place the tiny tubes (catheters) under the skin in the area where the cancer was. The tubes are sewn into place or held in place by a grid. The ends of the catheters stick out through small holes in the skin. Small stitches hold the catheters in place.
A machine places a radioactive seed into the tubes to deliver the radiation. Special precautions are taken to keep you and those around you safe from the radiation.
If high-dose radiation is used, the treatments are usually done as outpatient procedures twice a day for five days. Each treatment will last about an hour, and you will be able to leave the hospital after each one. During the treatment, a machine will move a small piece of radioactive material, called a radioactive seed, into the catheters. The seed will be left in for up to 10 minutes. After each treatment is finished, the seed is removed. Once all treatments are complete, the catheters and stitches are removed.
If low-dose radiation is used, the treatment is delivered over many hours or a few days. You have to stay in the hospital throughout the treatment because there will be radioactivity inside you while the seeds are in place. The radioactive seeds slowly deliver the radiation to the tissues surrounding the catheters. Once the treatment is complete, the radioactive seeds, stitches, and catheters are removed. Then you can go home.
Balloon catheter or applicator brachytherapy: What to expect
In balloon catheter or applicator brachytherapy, a special tube with a balloon or similar kind of device on the end is used. With careful planning, the balloon or applicator is placed into the area where the cancer was. It can be placed during lumpectomy or during a short procedure in a surgeon’s office soon after the lumpectomy.
The tube comes out through a little hole in the skin. The balloon or applicator stays in place for about a week and a half.
During each treatment, a machine places a radioactive seed into the balloon or applicator for about five to 10 minutes — just long enough to deliver the prescribed dose of radiation. A total of 10 treatments are usually given over five days. That means two treatments per day, about six hours apart. When the final treatment is done, the balloon is removed through the small hole in the skin.
Brachytherapy boost
Brachytherapy also can be used for giving a boost dose at the end of an external whole breast radiation treatment regimen. A boost dose is a supplemental dose of radiation given towards the end of your treatment to target the area around where the tumor was. The boost dose is given in the same manner as regular brachytherapy, using either small tubes, a balloon catheter, or an applicator. However, radiation boosts are usually given with external beam radiation rather than brachytherapy nowadays.
Benefits and drawbacks of brachytherapy
Brachytherapy was developed to reduce the risk of breast cancer recurrence while shortening the amount of time it takes to get radiation treatment. Brachytherapy also may limit the dose of radiation (and associated side effects) to the surrounding normal tissue including the heart and lungs.
Compared to external radiation, brachytherapy has several benefits:
The treatment time can be shorter — five days versus three to seven weeks with external radiation.
Radiation is given only to the area where the cancer is most likely to come back. Less of your body receives radiation, so there may be fewer side effects.
Results from studies done so far show a very low risk of recurrence after internal radiation.
But there are some unknowns involved with brachytherapy that should be discussed with your doctor as you make your treatment decisions:
Brachytherapy is only used after lumpectomy. It is not used after mastectomy.
Information on long-term outcomes with balloon or applicator brachytherapy is limited.
— Last updated on February 23, 2024 at 8:39 PM