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Breast cancer patients may have cancer cells remaining after a lumpectomy, making additional treatment necessary. The radiation oncologist may use HDR (high dose radiation) breast brachytherapy to kill any remaining cancer cells. This therapy delivers a precise, highly concentrated dose of radiation to the remaining cancer cells while limiting radiation exposure to surrounding, healthy breast tissue as well as some deeper organs, including heart and lungs. For this procedure, the surgeon and radiation oncologist work closely together.
Treatment is administered between one and four weeks after the lumpectomy. At this time a special catheter is inserted by the surgeon into the area where the tumor was located. A small balloon at the end of the catheter inside the breast may be inflated with sterile water. The catheter remains in the breast until treatment is complete., which is typically 5 treatment days, with two treatments each days, at minimum 6 hours apart If there is an intervening weekend, the catheter may be in the breast for 8-10 days.
Once the catheter is in place, an HDR machine is connected to the part of the catheter emerging from the breast and then radiation is delivered via radioactive “seed” to a targeted area. The seed is the size of a grain of rice. It is held in designated positions for a prescribed time to deliver the correct amount of radiation. The seed is removed after each treatment, though the catheter stays in the breast. After the final treatment is administered, the catheter is removed. No radioactive seeds remain in the body.
Brachytherapy devices that may be used in this procedure include:
SAVI (Strut Assisted Volume Implant) – This device has seven to 11 catheters, or struts, which are expanded once the device is inserted into the lumpectomy cavity. The radioactive seed travels through these catheters.
Mammosite – This is the balloon which is inserted into the lumpectomy cavity and inflated. Depending on the model, the Mammosite has one or four catheter through which the seed travels.
Contura – This balloon device has five catheters through which the seed travels. The device is capable of removing excess air or fluid from between the balloon and breast tissue.