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The medical community has a new way to offer patients breast cancer treatment. This new breast cancer radiation therapy option is through internal radiation. This is commonly known as breast brachytherapy.

This is done by placing a radiation source inside the body. This process has three important advantages:

• It places the radiation inside the lumpectomy cavity (the space left when a tumor is removed). The radiation is targeted to the area where cancer is most likely to recur.
• Radiation is delivered from the within the cavity, limiting the amount or radiation to healthy surrounding tissue, thereby reducing the potential for side effects to occur.
• The therapy can be completed in 5 days in an out patient setting.

Multicatheter Internal Radiation Therapy

For many years, internal radiation therapy has primarily been delivered using a complicated multi-catheter brachytherapy implant method that requires up to 25 catheters (tubes) to be placed in the breast. This type is also called intracavitary radiation therapy. After placement, a radioactive seed is delivered into each catheter to treat the target area. Doctors have been encouraged by recent studies in North America that have shown low local tumor recurrence rates (that is, a low rate of a tumor returning to the same place) using this technique to deliver the radiation.

A Simple Way To Deliver Radiation From The Inside

The MammoSite RTS is a new minimally invasive method of delivering internal radiation therapy following a lumpectomy for breast cancer. Therapy is given on an outpatient basis, so there is no need for a hospital stay and the treatment is completed in only 5 days.

The MammoSite® RTS is a single small balloon catheter than (A) fits inside the tumor resective cavity (the space left after the surgeon has removed the tumor). A tiny radioactive seed (B), connected to a machine called an afterloader (C), is inserted into the balloon and delivers the radiation therapy

This focuses the radiation dose on the area of the breast at highest risk for tumor recurrence. Radiation therapy with this device is preformed over a period of 1 - 5 days. When used alone, patients typically receive treatment twice a day for 5 days.

If your doctor feels that external beam radiation is appropriate for you, the MammoSite® RTS may also be used as a boost therapy in conjunction with external beam radiation. A boost is a procedure that delivers additional therapy directly to the area of the breast at highest risk for tumor recurrence.

The safety and effectiveness of the brachytherapy as a replacement for whole breast irradiation in the treatment of breast cancer has not been established. Please consult with your radiation oncologist to determine if you are an appropriate candidate for treatment with the MammoSite® RTS.

The Procedure

After lumpectomy, an uninflated balloon is placed inside the tumor resective cavity. The applicator shaft, a tube connected to the balloon, remains outside the breast (Figure 1). Once in place, the balloon is inflated with saline (sterile salt water) and a contrast agent, inserted through the applicator. (The contrast agent helps your doctor see the MammoSite balloon more clearly.) The balloon is filled to fit the edges of the cavity (Figure 2). The balloon will remain inflated for the entire time you are receiving radiation therapy.

Figure 1 After tumor removal surgery, an uninflated balloon is placed inside the tumor resection cavity.

Figure 2 Once in place, the balloon is inflated with saline and a contrast agent, inserted through the applicator catheter.

By placing the balloon inside the tumor resection cavity, the radiation source will be directly next to the area of the breast that is at the highest risk for tumor recurrence.

The MammoSite® RTS can be inserted either:

* During the lumpectomy procedure (at the time of the tumor removal)
* In a separate procedure under local anesthesia up to 10 weeks after the lumpectomy.

After the balloon is inserted, that area of the breast is cleaned, bandaged and you may return home. Radiation therapy can now begin under the direction of your physician.

Once The Balloon Is Placed, Radiation Therapy Can Begin

Treatment with the MammoSite® RTS is given on an outpatient basis, that is you do not require a hospital stay. Your radiation oncologist will develop a radiation plan customized for you. When used alone, typical treatment with the MammoSite® RTS would require 2 brief appointments a day for 5 days at North Shore Medical Accelerator or our oncology office at Huntington Hospital. If used as a boost inconjunction with external beam radiation, the MammoSite® RTS would require 2 brief appointments for only 1 day.

Radiation is emitted by a tiny radioactive seed attached by a wire to an afterloader. The afterloader is a computer-controlled machine that houses the radioactive source. The seed travels through the applicator into the inflated balloon (Figure 3). Where the seeds go and how much radiation is released is carefully determined by your radiation oncologist to effectively treat the cancer.

Figure 3 A radioactive seed attached to a wire delivers a precise dose of radiation

No source of radiation remains in your body between treatments or after the final treatment is completed. The tiny radioactive seed is only inserted during your treatment and is removed upon complete of your treatment. Neither the balloon nor the liquid inside is or will be radioactive in any way.

Once the final session is completed, the balloon is deflated and the MammoSite® RTS is easily removed. In most cases, you will not even require anesthesia for the removal (Figure 4).

Figure 4 After radiation treatment is completed, the balloon is deflated and removed.

Clinical Findings

The MammoSite® RTS has been carefully evaluated in a clinical trial. Following treatment, patients did experience minor breast-related side effects such as redness, bruising and breast pain. All of these are common side effects of breast surgery and/or radiation therapy. They usually last for only a short time. Some patients also experienced drainage from the insertion site. High patient satisfaction Patient Feedback about this treatment was positive. When asked, each of the 19 study patients surveyed said she would choose this treatment again and would recommend it to friends or family members as a treatment option to look into.

Currently our radiation oncologists perform MammoSite Treatments and serve Suffolk County, Long Island, New York at our office in Greenlawn, New York.