Breast cancer remains the most common female cancer. For a large percentage of patients, the recommended treatment strategy is organ-preserving tumour resection followed by adjuvant radiotherapy and chemotherapy. In the early stages of the disease, this treatment shows excellent aesthetic results and tolerability without compromising the quality of treatment. However, not all cancer patients know that one of the options for radiotherapy for breast cancer is brachytherapy, which has its unique advantages. These will be discussed in our article.
Brachytherapy – what is it?
Brachytherapy is a method of radiation therapy (radiotherapy), which consists of injecting a source of radioactive radiation inside the body. In the case of breast cancer treatment, it is placed after surgery where the tumour used to be. The main objective of brachytherapy is to destroy malignant cells that may have remained after the intervention, thus preventing the risk of recurrence.
According to numerous studies, in 69-90% of cases, breast cancer recurrence, if any, develops from the same place where the primary tumour was. Therefore, doctors pay special attention to irradiating this area. Adjuvant therapy can reduce the risk of recurrence by half (according to the EBCTCG study).
Unlike external beam radiation therapy, where the radiation comes from a special machine, brachytherapy uses tiny metal ‘seeds’ no bigger than a grain of rice. They are made of metal – usually titanium – with a radioactive substance (iodine, palladium, caesium or iridium) inside.
These seeds release radiation into the surrounding space. Because they are placed directly into the place where the tumour used to be, doctors can precisely target the area and use intense radiation. In comparison, with external radiotherapy, the doctor always has to consider the upper threshold of the available radiation dose, as the beam passes through healthy tissue on its way to the target, which must be protected. With brachytherapy, however, there are no such restrictions, so stronger doses can be safely administered. Most of the breast remains untouched, which is why this treatment is sometimes referred to as ‘partial breast irradiation’.
Advantages and disadvantages of brachytherapy for breast cancer:
Advantages of brachytherapy | Disadvantages of brachytherapy |
---|---|
Shorter period of irradiation | Brachytherapy can only be used after a lumpectomy. It is not used together with mastectomy |
Fewer side effects | Possible changes in the shape and form of the breasts |
Less radiation to the lungs and heart | ЗDepending on the type of procedure, require hospitalisation |
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How does brachytherapy help with breast cancer?
The effectiveness of brachytherapy lies in the way radiation affects living cells. In general, it harms any tissue due to the destruction of the DNA structure. Because cancer cells grow and divide very rapidly, they are more vulnerable to radiotherapy, leading to their degeneration and death. The doctor’s task, therefore, is to find the perfect balance – a dose of radiation that will destroy the cancer but leave no long-term effects on the body.
Brachytherapy for breast cancer is administered after a lumpectomy, a minimally invasive procedure during which the tumour is removed along with a small amount of surrounding tissue; often with neighbouring lymph nodes as well. The administration of radiation therapy after surgery is called adjuvant therapy.
Brachytherapy may also be used in some cases of treatment for breast cancer recurrence. In the past, the standard treatment protocol for such a diagnosis was mastectomy – the complete removal of the breast. However, more modern treatment approaches allow using repeat lumpectomy with brachytherapy for such patients. This treatment shows comparable results without negatively affecting the patient’s quality of life and perception of her body.
How does brachytherapy work?
Before treatment begins, all patients undergo a diagnostic test to help the doctor plan the treatment in detail. It is usually necessary to take X-rays and consult with a radio-oncologist. At this stage, the doctor will tell you everything about the upcoming treatment, how to prepare for it, and what to expect, including possible side effects.
Depending on the specifics, doctors may take different treatment approaches. For breast cancer, two types of brachytherapy are usually used: intracavitary and interstitial.
Intracavitary brachytherapy
This is the most commonly used approach in breast radiotherapy. It is also called balloon internal radiotherapy or MammoSite.
At the start of treatment, a puncture is made in the breast through which a thin silicone tube is placed up to the cavity where the tumour was. Sometimes this step can be combined with a lumpectomy to start radiation as soon as possible. Through this tube, a balloon is placed inside the breast – an expandable device that will serve as a container for the implanted ‘seeds’ of brachytherapy. These are used on average between 14 and 20 per patient.
Once the surgeon is satisfied that the balloon has been placed correctly, treatment can begin. Under ultrasound or CT scanning, the doctor will place the necessary dose of radioactive substance in special capsules inside the cavity formed by the balloon. They will stay inside the body for approximately 20 minutes, after which they are removed. This process must be repeated twice a day for 1-2 weeks.
Interstitial brachytherapy
Interstitial brachytherapy uses multiple catheters that are placed in the chest to deliver radiation sources. The second name for this technique is multicatheter internal radiotherapy.
Minimally invasive intervention for catheter placement is performed 1-2 weeks after lumpectomy. On average, 10-25 catheters are needed for proper effect. They remain in the chest until the end of treatment.
Under ultrasound or CT scanning, the doctor places radioactive seeds inside the catheters. They stay there through the treatment, irradiating a small area of the surrounding tissue. After 5-7 days, the catheters are removed. Since the source of radiation is inside the woman all this time, it is necessary to follow some safety rules during the treatment. The most important of these is to avoid contact with small children and pregnant women.
In modern cancer centres, computerised treatment planning systems are used to select the radiation dose. They take into account a large amount of data to find the ideal dose for each patient.
The types of brachytherapy also differ depending on the dose of radiation used to treat the patient. They are selected individually, depending on their specific needs. It is common to talk about high-dose, low-dose, ultra-low-dose and medium-dose brachytherapy. There is also a special type of radiation therapy called ‘pulse brachytherapy’. It uses more intense sources of radiation that release it over short regular intervals of time – ‘pulsed’.
With high-dose radiation therapy, patients usually do not need to stay in the hospital permanently. In contrast, low-dose radiotherapy usually means that the sources of radiation will remain in the body continuously, so these women need an inpatient stay.
Another use that brachytherapy has found in the treatment of breast cancer is ‘booster radiation therapy.’ It is used after the main course of external radiotherapy. The additional dose of radiation is administered using the same methods as for the full course.
Indications and contraindications for brachytherapy
Indications for brachytherapy for breast cancer are set by professional medical organisations such as the GEC-ESTRO Breast Cancer Working Group, the American Brachytherapy Society, etc.
Brachytherapy is usually recommended for patients with:
Ductal carcinoma in situ or invasive breast cancer;
Tumour measuring 3 cm or smaller;
Hormone-positive or hormone-negative cancer;
Lymph node biopsy that showed negative results;
Successfully achieved clean resection margins during surgery.
Breast volume also influences which radiation therapy method oncologists recommend for breast cancer patients: small breasts are more likely to be treated with external or intraoperative electron beam radiation therapy, while women with large breasts are more likely to be recommended for brachytherapy.
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Comparison of brachytherapy and external beam radiation therapy
Comparison criterion | Brachytherapy | External beam radiation therapy |
---|---|---|
Indications | Better suited to women with large breasts and deep tumour masses | Better for women with small breasts |
Technique | The radiation source is placed inside the breast using catheters or a balloon | The patient is irradiated using a special device with an external radiation source, e.g. LINAC |
Duration of treatment | 5-7 days | 3-7 weeks |
Effectiveness | Comparable treatment outcomes. Some studies suggest that brachytherapy carries a lower risk of recurrence, while others indicate that external beam radiation therapy will be more effective for some women | |
Aesthetic results | ~85% of patients are satisfied with the results | 72-75% of patients are satisfied with the results |
Side effects | 35-50% of patients deal with side effects, mostly mild and short-term; lower risk of heart and lung damage | Up to 61% deal with side effects, higher risk of long-term and severe complications |
Cost | ++++ | +++ |
Effectiveness and efficiency of therapy
Among all adjuvant breast cancer therapies, brachytherapy is one of the most researched. This means that evidence of its effectiveness and safety is abundant. Brachytherapy significantly reduces the risk of disease recurrence. For example, the European Organisation for Research and Treatment of Cancer (EORTC) presents figures such as these:
Among patients that underwent booster brachytherapy, the recurrence rate was only 2,5%, while after external photon radiation therapy, it was 4% and electronic radiation therapy 4,7%.
Also of concern for many women is the appearance of the body after treatment. According to a study conducted by GEC-ESTRO, 48% of female patients rated the way their breasts looked after brachytherapy as ‘excellent’, 37% as ‘good’, 13% as ‘normal’, and 2% as ‘bad’.
Side effects of breast brachytherapy
The side effects of brachytherapy after breast cancer surgery are less intense and less common compared to external beam radiation therapy, but they are still present. About half of the patients report mild complications, 39% report moderate complications, 10% report severe complications, and 1% report very severe complications.
Patients after brachytherapy may experience:
Sensitivity in the area of radiation;
Redness, ‘burning’ sensation;
Skin flaking and itching.
There is also a risk of infection in rare cases. Long-term side effects include changes in breast appearance, firmness, size or asymmetry. However, it is important to realise that changes occur as a result of both brachytherapy and surgery. Patients who are concerned about their appearance after cancer treatment should contact plastic surgeons who specialise in breast reconstruction. They can help restore them to a more familiar appearance and help the patient regain her self-confidence.
Most side effects of brachytherapy are temporary and go away on their own 1-2 weeks after treatment. However, you should always report any changes in your health to your doctor. Sometimes this can be an important signal for the doctor to modify their approach to treating your illness. Sometimes the doctor may offer you symptomatic treatment, which will significantly improve your health and well-being.
Where to go for treatment?
Summary
Brachytherapy is a way of administering radiation therapy for cancer. Brachytherapy is used as an adjuvant treatment for early breast cancer after lumpectomy.
On average, brachytherapy can reduce the risk of cancer recurrence by half.
The main advantages of brachytherapy include shorter treatment duration, fewer side effects, less toxicity to the heart and lungs, and better aesthetic results.
There are two main options for brachytherapy for breast cancer: intracavitary/balloon/MammoSite and interstitial/catheter. Treatment courses can also vary depending on the intensity of the dose.
On average, brachytherapy for breast cancer takes 5-7 days (a hospital stay may be required for this period) and is relatively well tolerated by patients. The most common side effects include itching, sensitivity, and redness of the breasts. These usually resolve on their own in 1-2 weeks after the course is completed.
MediGlobus doctors recommend clinics with strong radiotherapy departments: Medicana Ataköy, Liv Vadistanbul (Turkey), Köln University Hospital (Germany), Quironsalud Madrid Hospital (Spain), Samsung Clinic (South Korea), and Fuda Clinic (China).
SIGN UP FOR BRACHYTHERAPY
To make an appointment for this procedure abroad, click on the button below and fill out the form. Our coordinators will call you back within 30 minutes. They will provide you with all the necessary information and help you organise your trip.
Sources:
- 1. Breast Cancer Org
- 2. Breast Care: The Role of Brachytherapy in the Treatment of Breast Cancer
- 3. The Role of Interstitial Brachytherapy for Breast Cancer Treatment: An Overview of Indications, Applications, and Technical Notes
- 4. Menopause Review: Brachytherapy in breast cancer: an effective alternative
- 5. Breast Cancer Research and Treatment: Patient-reported cosmetic satisfaction and the long-term association with quality of life in irradiated breast cancer patients