October 30, 2009

Up Close and Quick
Brachytherapy can bring radiation therapy within reach for some
breast cancer patients

By Kathy Ursprung
The Chronicle

     Breast cancer patients who undergo conventional radiation therapy commit to five to seven weeks of daily treatment, often at a distant treatment center, but a therapy coming to the Celilo Cancer Center will change that for some of those patients.
     For some women, that weeks-long commitment can mean the difference between life and death.
     “Studies show the further you are away from a radiation treatment center, the more likely you are not to have radiation treatments in breast cancer,” said Dr. Keith Stelzer, Celilo's medical director.
     Going without radiation treatment increases the probability of the cancer coming back and lowers the probability of survival, Stelzer said.
     Recently, Celilo obtained the equipment needed to perform brachytherapy, a method of radiation delivery that reduces treatment time from weeks to five days, an easier period of time for a patient to be away from home and work.
     “'Brachy' means 'close' in Latin,” Stelzer explained.
     While conventional radiation treatment uses an external radiation source, brachytherapy uses implants of high-dose radiation to deliver the treatment.
Doctors use a computer to plan out the shape of the radiation dose, then direct a robot with a guidewire to hold the radiation source in place, usually for less than five minutes.
     “It's an option for patients with breast cancer and also for certain types of uterine cancer and cervical cancer,” Stelzer said. “It's not necessarily better, but it provides another option for patients who meet certain criteria.”
     Not everyone is a candidate for brachytherapy, Stelzer noted. Candidates for the localized treatment are women at least 45 years old with a relatively small, well-defined tumor.
     “The surgical margin has to be clear, a single focus of the tumor, rather than multiple points,” Stelzer said, “and the lymph nodes have to be uninvolved.
     “As a rough guess, maybe about a third of patients may turn out to be candidates,” Stelzer said.
     The shape of the treatment is tailored to the specific tumor. Doctors implant a balloon into the breast with a central canal and run a catheter to it. The balloon forms a spherical area, which is filled with fluid to maintain its size and shape. The radioactive source goes in through the central tube and is held in position for the time needed to deliver the prescribed dose each session.
     Treatments are delivered twice a day, separated by about six hours.
     “After the last treament, we deflate the catheter and that's it,” Stelzer said.
It can be a particularly exciting option for women who live in the more distant reaches of the Celilo Cancer Center's geographically vast service area.
     “Especially for someone considering having a mastectomy just because of the distance consideration,” Stelzer said.
     The radioactive source for the brachytherapy treatment is expected to arrive sometime in November, allowing such treatments to begin.
     “We're the first nationally accredited breast care center in the state,” Stelzer noted. “This is another option in an array of services available in the breast program.”