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Partial Irradiation Effective for Small, Early Breast Cancers: Your Health

By Rallie McAllister, M.D., MPH, MSEH

For many women diagnosed with breast cancer, treatment of the disease can seem just as devastating as the diagnosis.

According to Marisa Weiss, M.D., founder of breastcancer.org and director of breast radiation oncology at Philadelphia's Lankenau Hospital, "Today, the majority of breast cancers are detected early, while they're still very treatable. As a result, most women can expect long-term survival."

Treatment of early stage breast cancer traditionally involves performing one of two surgeries. A mastectomy is the surgical removal of the entire breast.

Breast-conserving surgery, also known as a lumpectomy, involves removing the cancer, as well as a small margin of normal tissue. Following a lumpectomy, the remaining breast tissue is usually treated with radiation to destroy any cancer cells that might have been left behind.

While lumpectomy followed by whole-breast irradiation is known to be as effective as mastectomy in women with early stage breast cancer, treatment is demanding and difficult. Women receiving whole-breast irradiation must arrange for daily transportation to and from the hospital for a period of six or seven weeks.

Fortunately, a new treatment option, called partial-breast irradiation therapy, is now available for women with small, early stage breast cancers. Partial-breast irradiation involves delivering a concentrated dose of radiation only to the affected tissue, rather than to the entire breast.

"We know that the greatest risk of cancer recurrence is at the 'scene of the crime,' or that part of the breast that was affected by the cancer," said Weiss. "It is this understanding that led to the development of a new treatment approach."

Partial-breast irradiation therapy is administered using a device called the MammoSite, which consists of a small, soft balloon attached to a thin tube, or catheter. Following removal of the cancerous tissue, the surgeon places the balloon into the empty space that remains.

The balloon is then filled with fluid and attached to one end of the tube of the MammoSite device. The tube is passed through a small incision in the skin, so that the other end remains outside the breast.

Once the device is inserted, it will remain in place for about a week, so that treatments can be administered. During each treatment, a radioactive pellet is passed through the tube and into the balloon.

The radioactive pellet remains inside the balloon only for about five to 10 minutes before being removed. During the time that it remains in place, the pellet releases the proper dose of radiation to the nearby tissue.

From start to finish, each treatment session normally lasts less than an hour. After receiving a dose of radiation twice daily for five days, the therapy is complete.

When the last treatment is administered, the balloon is deflated, and the entire MammoSite device is removed from the breast. The tiny skin wound left by the tube is closed with small strips of paper tape.

"Partial-breast irradiation is a very attractive treatment option for many women with early stage breast cancer," said Weiss. "It only lasts a week, and it's not nearly as demanding as whole-breast irradiation."

In addition, radiation is delivered from inside the breast, directly to the area where cancer is most likely to recur. Because patients receive smaller doses of radiation, the side effects are typically minimal.

In an ongoing study of nearly 1,500 women who received partial-breast irradiation therapy with the MammoSite device, results are encouraging. Less than 1 percent of women undergoing the therapy experienced a recurrence of cancer in the treated breast after five years.

These results are similar to those achieved in women treated with whole-breast irradiation after breast-conserving surgery. In addition, about 93 percent of women treated with partial-breast irradiation reported experiencing good or excellent cosmetic results.

"This study involves a small number of women over a relatively short period of time," said Weiss. "More research is needed to find out how partial-breast irradiation therapy compares to whole-breast irradiation therapy, which is still the standard of care for breast cancer treatment."

Whole-breast irradiation treatment has been studied for more than three decades in thousands of women with breast cancer, and has been shown to significantly reduce the likelihood of cancer recurrence.

Weiss stressed that partial-breast irradiation therapy may not be the best treatment for every woman with breast cancer.

"Every patient is different, and every breast cancer is different" she said. "Women should discuss all treatment options with their physicians to determine which one is best for them."

Rallie McAllister, M.D., M.P.H., is a family physician in Kingsport, Tenn., and author of "Healthy Lunchbox: The Working Mom's Guide to Keeping You and Your Kids Trim." Her Web site is http://www.rallieonhealth.com.

Categories: Health & Wellness, Women's Health,

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