Brachytherapy for Breast Cancer

Author: OncoLink Team
Content Contributor: Courtney Misher, MPH, BSRT(T)
Last Reviewed:

What is Brachytherapy? 

Brachytherapy is a form of radiation treatment where a source of radiation is put inside your body (internal radiation). This can be an option for certain women after lumpectomy, depending on the size and location of the cancer. Brachytherapy allows a higher dose of radiation to go directly to the area where the tumor was before surgery. It can also be used to give an extra “boost” of radiation after radiation to the whole breast. 

Brachytherapy is one way to deliver accelerated partial-breast radiation (APBI). APBI gives a larger dose of radiation over a shorter period of time. It only gives radiation to the area of the breast where the cancer was, not the entire breast. There are two types of brachytherapy used for breast cancer, intracavitary and interstitial. 

Incision in breast where MammoSite balloon is inserted.

Intracavitary Brachytherapy (Balloon Internal Radiation or MammoSite)

This is the most common type of brachytherapy used for breast cancer. It targets the area where cancer is most likely to re-occur. This procedure uses a tube with a balloon on one end that is placed in the area of the breast where the cancer was. The tube comes out of the skin through a small hole. This device can be placed either during lumpectomy surgery or afterward as an outpatient procedure. 

CAT Scan images illustrating MammoSite balloon in treatment position with dummy seeds (non-radioactive seeds).

What can I expect during intracavitary brachytherapy treatment?

The deflated balloon is placed into the space in the breast where the tumor was removed from. The balloon is filled with saline (saltwater), until it fits comfortably in the space. The opposite end of the catheter tube stays outside of the breast. Most people do not experience discomfort while the balloon is being placed or filled with saline.  

Once the balloon has been placed, a CT scan of the breast is done to make the treatment plan. The plan is made specifically for each patient. During the treatment, a machine (called an afterloader) places radioactive seeds into the balloon through the catheter for about 5 to 10 minutes. Typically, these are given as 2 treatments per day. The 2 treatments are given at least 6 hours apart. Often 10 treatments are given over 5 days. After completing all of the treatments, the tube and the balloon are removed through the existing hole in the skin.

Interstitial Needle-Catheter Brachytherapy (Multi-catheter Internal Radiation)

This procedure also uses radioactive seeds to deliver radiation directly to the area where the cancer was. The seeds are placed in small tubes (catheters) that are sewn under the skin. The tubes stick out through little holes in the skin. This type of treatment can be given as high-dose radiation or low-dose radiation.  

  • High Dose Radiation: High dose radiation is more common and is given as an outpatient procedure. Each appointment is about 1 hour long. The actual treatment will only last about 10 minutes. It is common for this type of procedure to be done 2 times a day for 5 days for a total of 10 treatments. Once all of the treatments have been completed, the catheter and stitches are removed. 
  • Low-Dose Radiation: Less often, low-dose radiation is used. This treatment is given over several hours or a few days. This treatment is done in the hospital. During this time, you will slowly be receiving the radiation. You will have radioactive seeds inside you during this time. Once treatment is complete, the seeds, stitches and catheters are removed, and you can go home. 

Side Effects with Brachytherapy

Some side effects that are possible with brachytherapy are:

  • Bruising or redness at the treatment site.
  • Pain in the breast.
  • Infection.
  • Fatty tissue damage in the breast.
  • Fluid collection in the breast.
  • Fracture of the ribs, which is rare.

Who might brachytherapy be a treatment option for?

Brachytherapy is not a treatment option for all breast cancer cases. This may be an option for people who meet certain criteria:

  • Have a lumpectomy.
  • The tumor is less than 2 cm for invasive cancer or 2.5cm for ductal carcinoma in situ (DCIS).
  • The cancer is hormone receptor (HR) positive.
  • The person is BRCA negative.
  • They do not have cancer in the lymph nodes.
  • They are 50 years or older.
  • Have had a lumpectomy for early-stage cancer.

Advantages and Disadvantages of Brachytherapy

Benefits of brachytherapy compared to external radiation: 

  • It limits the amount of radiation to surrounding normal tissue and structures including the heart and lungs. 
  • Treatment duration is much shorter – 5 days compared to several weeks.
  • Radiation is focused only to the area where the cancer is most likely to return. Less radiation to the normal tissue causes fewer side effects.
  • In early-stage cancer, brachytherapy has been shown to be very good at preventing cancer from coming back after surgery.

Disadvantages of brachytherapy:

  • It is used after lumpectomy. If an individual has a mastectomy, it likely will not be an option.
  • The look and feel of the breast after treatment may not be as good with brachytherapy compared to external radiation.
  • It is not available at all hospitals or oncology clinics.
  • In some cases, the procedure is done as an inpatient procedure so you will need to stay at the hospital. 

Choosing Your Treatment

Not all breast cancers can be treated with brachytherapy. You should discuss all treatment options with your providers. It is important to discuss possible side effects from each treatment and what your best option is. 

References

American Cancer Society. (2019, September 18). Radiation for Breast Cancer. Retrieved from https://www.cancer.org/cancer/breast-cancer/treatment/radiation-for-breastcancer.html#:~:text=Intracavitary%20brachytherapy%3A%20This%20is%20the,there%20until%20treatment%20is%20complete

Correa, C., Harris, E. E., Leonardi, M. C., Smith, B. D., Taghian, A. G., Thompson, A. M., ... & Harris, J. R. (2017). Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Practical radiation oncology7(2), 73-79. 

Kauer-Dorner D., Berger D.: The Role of Brachytherapy in the Treatment of Breast Cancer. Breast Care 2018; 13:157-161. Doi: 10.1159/000489638. Retrieved from https://www.karger.com/Article/FullText/489638

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