Brachytherapy: One-time treatment for early breast cancer

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After breast cancer surgery, women traditionally undergo external beam radiation, which means a trip into a treatment center as often as five days a week for three to six weeks. But for patients who live far away, that travel can be a burden.

Now, there's a targeted therapy that could provide a solution.

For Kathleen DePalo, being gathered around the dinner table with her extended family means the world to her, especially after fighting breast cancer.

"I was never one for self-examination, and that was a big mistake," she said.

In December 2017, DePalo was diagnosed with Stage 1 breast cancer.

Making lengthy, repeated trips into Manhattan for treatment wasn't a good option. At the time DePalo was caring for her chronically ill husband, John.

"I had the anxiety that I would have to leave him every day," she recalled.

But surgical oncologist Dr. Elisa Port and radiation oncologist Dr. Sheryl Green recommended another option.

"Brachytherapy, or the therapy we are talking about, uses specific devices to really plant radiation directly at the source of the tumor," Green said.

"The devices to deliver the radiation have been perfected and refined, and I think we are giving it at a much higher level," Port said.

Using a system called Intrabeam, an intraoperative radiation therapy, the radiation takes up to 45 minutes and is administered right after the procedure. It only has to be done once.

"I woke up and my radiation was over," DePalo said.

She now has more days like this and more time with the people who matter most.

Green and Port say the radiation therapy is not for everyone. Patients must be Stage 1 and be postmenopausal. There must be no chance of microscopic areas of cancer in other parts of the breast. The patient must also have no evidence of cancer in the lymph nodes.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY
TOPIC: BRACHYTHERAPY: ONE-TIME TREATMENT FOR EARLY BREAST CANCER
REPORT: MB #4629

BACKGROUND: In Stage 1 breast cancer, cancer is evident, but it is contained in only the area where the first abnormal cells began to develop. The breast cancer has been detected in the early stages and can be very effectively treated. Stage 1 can be divided into Stage 1A and Stage 1B. The difference is determined by the size of the tumor and the lymph nodes with evidence of cancer. Even though Stage 0 breast cancer is considered "non-invasive," it does require immediate treatment, typically surgery or radiation, or a combination of the two. Chemotherapy is usually not part of the treatment regimen for earlier stages of cancer. Stage 1 is highly treatable; however, it does require immediate treatment, typically surgery and often radiation, or a combination of the two. (Source: https://www.nationalbreastcancer.org/breast-cancer-stage-0-and-stage-1)

TREATMENT: External beam therapy (EBT), also called external radiation therapy, is a method for delivering a beam or several beams of high-energy x-rays to a patient's tumor. Beams are generated outside the patient and are targeted at the tumor site. These high energy x-rays can deposit their dose to the area of the tumor to destroy the cancer cells and, with careful treatment planning, spare the surrounding normal tissues. No radioactive sources are placed inside the patient's body. The treatment process can take one hour or less each day and most of the time is often spent positioning and imaging the patient. The first treatment usually takes the longest; subsequent treatments take between 15 and 30 minutes. The actual treatment may last only several minutes. The duration of a patient's treatment depends on the method of treatment delivery, such as IMRT, and the dose given. The length of each treatment will usually be the same from day to day. Patients usually receive radiation treatments once a day, five days a week for a total of two to nine weeks. The patient's diagnosis determines the total duration of treatment. Occasionally, treatments are given twice a day. (Source: https://www.radiologyinfo.org/en/info.cfm?pg=ebt)

BRACHYTHERAPY: Brachytherapy delivers radiation therapy directly to the location of the cancer cells inside the breast. 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. (Source: https://www.mountsinai.org/health-library/surgery/partial-breast-brachytherapy)