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Partial breast brachytherapy

Breast cancer - partial radiation therapy; Carcinoma of the breast - partial radiation therapy; Brachytherapy - breast; Adjuvant partial breast radiation - brachytherapy; APBI - brachytherapy; Accelerated partial breast irradiation - brachytherapy; Partial breast radiation therapy - brachytherapy; Permanent breast seed implant; PBSI; Low-dose radiotherapy - breast; High-dose radiotherapy - breast; Electronic balloon brachytherapy; EBB; Intracavitary brachytherapy; IBB; Interstitial brachytherapy; IMB

Brachytherapy for breast cancer involves placing radioactive material in the area where breast cancer has been removed from the breast.

Cancer cells multiply faster than normal cells in the body. Because radiation is most harmful to quickly growing cells, radiation therapy damages cancer cells more than normal cells. This prevents the cancer cells from growing and dividing, and leads to cell death.

Description

Brachytherapy delivers radiation therapy directly to where cancer cells inside the breast are located. It may involve placing radioactive sources into the surgery site after removing a breast lump lumpectomy. The radiation only reaches a small area around the surgery site.It does not treat the entire breast. The goal is to limit side effects of radiation to normal tissue.

There are different types of brachytherapy. There are at least two ways to deliver radiation from inside the breast.

INTERSTITIAL BRACHYTHERAPY (IMB)

  • Several small needles with tubes called catheters are placed through the skin into the tissues around the lumpectomy site. This is most often done 1 to 2 weeks after surgery.
  • Mammography, ultrasound, or CT scans are used to place the radioactive material where it will work best to kill the cancer.
  • The radioactive material is placed in the catheters and remains for 1 week.

INTRACAVITARY BRACHYTHERAPY (IBB)

  • After breast lump removal, there is a cavity where the cancer was removed. A balloon with a tube (catheter) that has channels running through it can be inserted into this cavity. Later, radiation in the form of tiny radioactive pellets can go into the channels, delivering radiation from inside the balloon. There are other devices without an actual inflatable balloon. Treatment is often done several days after surgery at the health care provider's office. Sometimes the catheter is placed during the first surgery while you are asleep.
  • Ultrasound or CT scans are used to place the radioactive material where it will work best to kill the cancer while protecting adjacent tissues.
  • The catheter remains in place for around 1 to 2 weeks and is removed at your provider's office. Stitches may be needed to close the hole from where the catheter is removed.

Brachytherapy may be given as low dose or high dose:

  • Those receiving low-dose treatment are kept in the hospital in a private room. Radiation is slowly delivered over hours to days.
  • High-dose therapy is provided as an outpatient over 5 or so days. Sometimes the treatment is delivered two times in a single day, separated by 4 to 6 hours between sessions. Each treatment takes about 15 to 20 minutes.

Other techniques include:

  • Permanent breast seed implant (PBSI), in which radioactive seeds are individually inserted through a needle into the breast cavity several weeks after lumpectomy.
  • Intraoperative radiation therapy is delivered in the operating room while you are asleep after breast tissue is removed. The treatment is completed in less than an hour.

Why the Procedure Is Performed

Breast brachytherapy helps prevent breast cancer from returning. The radiation therapy is given after lumpectomy or partial mastectomy. This approach is called adjuvant (additional) radiation therapy because it is adding a treatment beyond surgery.

Because these techniques are not as well studied as whole breast radiation therapy, there is not full agreement about who is most likely to benefit.

Types of breast cancer that may be treated with partial breast radiation include:

  • Ductal carcinoma in situ (DCIS)
  • Invasive breast cancer

Other factors that may lead to the use of brachytherapy include:

  • Tumor size less than 2 cm to 3 cm (about an inch)
  • No evidence of tumor along the margins of tumor specimen removed
  • Lymph nodes are negative for tumor, or only one node has microscopic amounts

Before the Procedure

Tell your provider what medicines you are taking.

Wear loose-fitting clothes to the treatments.

After the Procedure

Radiation therapy can also damage or kill healthy cells. The death of healthy cells can lead to side effects. These side effects depend on the dose of radiation, and how often you have the therapy.

  • You may have warmth or sensitivity around the surgical site.
  • You could develop redness, tenderness, or even an infection.
  • A fluid pocket (seroma) could develop in the surgical area and may need to be drained.
  • Your skin over the treated area may turn red or dark in color, peel, or itch.

Long-term side effects may include:

  • Decreased breast size
  • Increased firmness of breast
  • Skin redness and discoloration

Outlook (Prognosis)

There have been no high-quality studies comparing brachytherapy to whole breast radiation. However, other studies have shown outcomes to be the same for women with localized breast cancer.

References

Holloway CL, O'Farrell DA, Devlin PM, Stewart AJ. Brachytherapy. In: Gunderson LL, Tepper JE, eds. Clinical Radiation Oncology. 4th ed. Philadelphia, PA: Elsevier; 2016:chap 15.

National Cancer Institute website. Breast cancer treatment (PDQ) - health professional version. www.cancer.gov/types/breast/hp/breast-treatment-pdq. Updated May 31, 2018. Accessed August 2, 2018.

National Cancer Institute website. Radiation therapy and you: support for people who have cancer. www.cancer.gov/publications/patient-education/radiationttherapy.pdf. Updated October 2016. Accessed August 2, 2018.

Shah C, Harris EE, Holmes D, Vicini FA. Partial breast irradiation: accelerated and intraoperative. In: Bland KI, Copeland EM, Klimberg S, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 51.

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          Review Date: 7/9/2018

          Reviewed By: David Herold, MD, Radiation Oncologist in West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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