BRACHYTHERAPY: VBCF’S POSITION

Brachytherapy has been available in various forms for treatment of various cancers for some time. Until recently, the most common use in breast cancer was for the "boost" at the end of standard radiation treatments. More recently radiologists in the U.S. and Europe have been investigating brachytherapy as an alternative modality of radiation treatments for women after lumpectomy. Not all women who have a lumpectomy are candidates for brachytherapy. To be eligible, the tumor must be less than 3cm, there can be no cancer at the surgical margins, and there must be no positive lymph nodes containing cancer.

Most of the large studies of women who have received brachytherapy involve the use of interstitial brachytherapy, which is the insertion of 9-15 catheter probes that place radiation seeds in the breast. The new FDA-approved MammoSite device, approved in May 2002 delivers brachytherapy into the breast via a balloon type catheter device into the a fluid-filled seroma where the tumor used to be, and a single radiation seed is placed in it twice a day for 4-5 days (HDR). If there is no seroma or it is not the correct size or shape, then traditional breast brachytherapy may also be possible. After the last treatment, the balloon is deflated, and the device is pulled out.

The advantage of brachytherapy over traditional radiation is that treatment takes 5 days instead of approximately 6 weeks, less of the breast gets treated (not the entire breast), less of the skin, ribs, lung and heart gets treated. Since the vast majority of local recurrences of early stage breast cancer occur very close to the original tumor site, brachytherapy, with no increase in radiation, targets this site.

Another advantage is that chemotherapy can be started (if required). “ There is an 8 week delay in chemotherapy if external beam radiation is given first and there is typically a 3.5 month delay if external beam radiation is given after chemotherapy, noted Dr. Robert R. Kuske of the Univ. of Wisconsin at Madison when presenting 10 year follow-up data on the more than 300 women he has treated with brachytherapy following lumpectomy since 1991.” (Reuters Health 10/14/02). If this treatment proves to be as effective as traditional radiation, women who might have otherwise chosen a mastectomy over lumpectomy because of access to treatment and time issues may opt for a lumpectomy with brachytherapy.

CONCLUSION: Initial results from ongoing trials of brachytherapy as an alternative modality after lumpectomy are promising, and VBCF hopes the final trial data will prove this is an equally effective option to traditional radiation therapy. We look forward to the peer-reviewed results of phase III trials.