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.
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 one week.
INTRACAVITARY BRACHYTHERAPY (IBB)
- After breast lump removal, there is a cavity where the cancer was removed. A balloon with channels running through it can be inserted into the breast. Later, radiation in the form of tiny pellets can go into the channels, delivering radiation from inside the balloon. There are other devices without an actual inflatable balloon. This is often done several days after surgery.
- Ultrasound or CT scans are used to place the radioactive material where it will work best to kill the cancer.
- The catheter remains in place for around 1 to 2 weeks.
Brachytherapy may be given as low dose or high dose:
- Those receiving low-dose treatment are kept in the hospital in a private room.
- High-dose therapy is provided as an outpatient over 5 or so days. Sometimes the treatment is delivered 2 times in a single day, separated by 4 to 6 hours between sessions.
Other techniques include:
- Permanent breast seed implant (PBSI), which is placed through the skin 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. A major issue is that the treatment is done without knowing the final report on the type of tumor.
Why the Procedure Is Performed
Breast brachytherapy helps prevent breast cancer from returning. The radiation therapy is given after breast-conserving surgery. This approach is called adjuvant (additional) radiation therapy.
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 health care 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 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
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.
Hepel JT, Wazer DE. A comparison of brachytherapy techniques for partial breast irradiation. Brachytherapy. 2012;11(3):163-75. PMID: 21816686 www.ncbi.nlm.nih.gov/pubmed/21816686.
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. Breast cancer treatment (PDQ). Cancer.gov Web site. Updated August 11, 2016. www.cancer.gov/types/breast/hp/breast-treatment-pdq. Accessed September 13, 2016.
National Cancer Institute. Radiation therapy and you: support for people who have cancer. Cancer.gov Web site. www.cancer.gov/publications/patient-education/radiation-therapy-and-you. Accessed September 13, 2016.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): breast cancer. Version 2.2016. www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed September 13, 2016.