Mammosite: Pro's & Con's?????

O3132W

Mammosite: Pro's & Con's?????

O3132W

I have 1 week to make my choice between Mammosite Radiation or Full course radiation.

I would appreciate any input that might help me with this decision  When I saw the Rad doctor he kinda scared me about the Mammosite due to possible exposure to infection.  Assuming my Lump.results make me a candidate for the Mammosite, I need to inform my surgeon before the surgery if I option for Mammosite so that she can prepare for the balloon to be placed later.  Thank you in advance.

idaho

I am sorry I can't help you- I had full course radiation- it really is not bad.  Some questions you might ask; what is the percentage of risk for infection?  Which one works better?  Where are the studies that back that up?  Someone will be along to help you.  Tami

BonnieB13

I'm sorry I didn't see this question until now. I did mammosite radiation 6 months ago and was extremely glad I was able to. It was twice a day for 5 days, not painful during the radiation and very interesting. It was much easier and there weren't any skin problems to deal with.

 I would choose mammosite again in a heartbeat. I'm now a fan...

O3132W

BonnieB13:   Your response is informative for me.  I sent you a Personal Message.  Did you get it?

dietcoke

I had Mammosite in March.  The radiation wasn't bad.  Unfortunately I did get a nasty infection afterwards.  They usually prescribe Keflex antiobiotic to prevent infection.  Because I am allergic to Keflex they gave me a zpack which you take for 5 days but is supposed to keep working afterwards.  The balloon was in for 8 days.  It just didn't prevent an infection.  A week after the balloon was taken out I had to go back to the surgeon who had to aspirate it and I was then on two heavy dose antiobiotics for 14 days.  Had I not gotten the infection the Mammosite would have been great.

If you choose the Mammosite route be sure they give you an antiobiotic that covers the whole time the balloon is in.

O3132W

Dietcoke:  Thanks for you account of your experience.  Sending PM

elimar86861

I just want to point out that you see this listed often as 5-day treatment.  Well, you will have the device implanted for some days (even a week, maybe) before you will begin the radiation.  Unless you have the treatments Mon. thru' Fri., you can include an extra weekend in there as well.  So, all who are considering this might want to be clear on ACTUAL lenght of time you will have the balloon catheter in place.  Infection is a possibility as long as it is creating an opening in the skin.  Check with doctor beforehand.

My experience was with a Contura device, similar ro Mammosite.  I wore it only 4 days, and it HURT the entire time.  The location of my lump cavity was very near to the skin and I think that is what created the discomfort.  I was told it was too near the skin to even have the treatment, so it got removed.  I felt some relief 10 minutes after it was removed.   I initially chose this because I wanted to limit my body's exposure to radiation, not so much the "5 days" vs. 6 weeks. 

Before I knew that it had to come out, I was told that I would have to wait til the following week to get in the radiation appt. schedule.  Because of the hurting I mentioned above, I had an actual pain/rage cryfest right in the doctor's office. While I really wanted this method, I just did not know if I could stand the discomfort being extended for another week!  I think "most women" have "mild discomfort."  I'm not a wimp, but it felt pretty bad to me.

jennies

Your doctors will carefully evaluate your cancer to determine if you are a candidate for MammoSite 5-day Targeted Radiation Therapy. The American Society of Breast Surgeons and the American Brachytherapy Society recommend this treatment for early-stage breast cancers that are 3 cm (about the size of a walnut) or smaller, with limited or no spread of cancer to the lymph nodes.

Clinical studies of MammoSite Therapy have shown it to be well tolerated, with mild side effects that generally last for a short period of time.6 Side effects that occurred most frequently include redness, bruising and mild breast pain. These did not occur in all patients. These are all common side effects of breast surgery and/or radiation therapy and usually go away after a short period of time.

The MammoSite balloon catheter is secured with gauze to the side of the breast so that you can go about your normal activities in between treatments. Most women feel little or no discomfort during insertion of the catheter, during treatment, or during removal of the catheter. There can be some drainage that occurs from the catheter insertion site, which is normal; this should also go away after a short period of time.

You should talk to your doctor about all of the risks and benefits of your treatment.

Denver Radiation Oncologist

linn56

I asked my doctors about it and was told, in no uncertain terms, "We used to do that, results were not good enough,  we don't use it anymore; but just do standard radiation.". So I am surprised to hear people are still getting it, because the impression they gave me was that it was currently out of favor. But I have no hard facts to back anything up. Are there regional trends for Mammosite vs. regular radiation?  I am in the Chciago area.

mstxrn22

My mom had her lumpectomy a week ago (7mm ductal carcinoma). She never mentioned to me that she and her doctor talked about this MammoSite thing.  She said he mentioned a 'port' for radiation, but that it's usually not covered by insurance. I was talking with her last night and she said she felt and heard water in her breast sloshing around. She said there's no catheter or anything coming out of her skin. I asked her if she actually consented to this and she said she didn't remember because between the mammogram, biopsy, diagnosis and lumpectomy, everything happened so fast. So, she was going to call her insurance today to see if radiation by MammoSite is covered.  If it isn't, she'll do standard treatment...but I'm not pleased with her surgeon at this point. He implanted this thing she doesn't even know if she wants to use that will have to come out.  She lives in a different state from me, so I can't be there with her at her appointments, but I am a nurse, so I feel like she didn't have full informed consent. She's got some redness at her incision site, so he put her on antibiotics.  She goes for her follow up on Monday...11 days post op. I suppose we'll have to see if it's covered and she can have it.  If so, 5 days of treatment is far better than 6 weeks.

 ***UPDATE: Found out it is covered by her insurance...so that's a relief. :-)

peachy-pie

I had a lumpectomy 3 days ago (7/05/11) and I am due to have a Mammosite catheter put in on 7/14/11.   I was told by my radiologist that it will be uncomfortable but it will not be painful.   Uncomfortable because i'll have a tube sticking out of the side of my breast,  but it will only be there for 8 days until it is removed.   And if I can have 5 days of radiation treatments VS 6 weeks of treatments,  i'll learn to deal with it.   Downside is you are not allowed to shower or get it wet as it can cause infection.   I was told i'd be given a prescription for Keflex to prevent infection as a precaution.   I am still very swollen and sore from my surgery,  so I am hoping that I am not as sore as this on the 14th when I am to have the catheter put in.   I am still waiting to get my Pathology report back, that will decied whether or not I can still have the mammosite radiation.  I hope I am still elidgible for it, as I want this all behind me as soon as possible so I can get on with life.   Still not sure about Chemo,  but from what the doctor is saying,  he doesn't think I am going to need it.   But again,  that will all depend on what the apth report says.    

cycle-path

"I asked my doctors about it and was told, in no uncertain terms, "We used to do that, results were not good enough, we don't use it anymore; but just do standard radiation.". So I am surprised to hear people are still getting it, because the impression they gave me was that it was currently out of favor"

Linn, there is one reason and one reason only that it is "out of favor," and that is that the ROs don't make as much money from doing it. Only 10 treatments, and not as much prep (tattoos, etc.)

It's all about the money. 

peachy-pie

I was told this type of radiation is just as good,  if not better then standard radiation because it targets the tissues where the tumor used to be and they can channel it now,  where they didn't used to be able to do that.   So they have the ability to treat exactly what needs to be treated.   I was told there are less side effects,  and to have treatments over in 5 days compared to 6 weeks is quite amazing.   I was told it is precise and accurate,  and even though the catheter may be uncomfortable,  I am willing to deal with it for a week if I can avoid the long term radiation of 6 weeks.

 

redsox

Accelerated Partial Breast Irradiation (APBI), for which Mammosite is one method, is a newer technology with shorter follow-up data than whole breast irradiation and is usually recommended only to patients at low risk who meet specific conditions.  The rationale is that the area nearest the tumor site has the highest risk of recurrence so treating just that area with radiation therapy will reduce the rate of recurrence in the area at highest risk.  The rest of the breast, which is treated with whole breast irradiation but not with APBI, does have some risk of recurrence, but for carefully selected patients that risk may be quite low. 

The following article describes guidelines from the major professional society of radiation oncologists for APBI based on the data available.

http://www.redjournal.org/article/S0360-3016(09)00313-7/abstract

Criteria for being "suitable" for APBI include patient age >=60 years old, no BRCA 1/2 mutation, tumor size <= 2 cm., Stage T1, margins negative by at least 2 mm., no lymph-vascular space invasion, ER+, unicentric only, clinically unifocal with total size <= 2 cm., invasive ductal or other favorable histology, not pure DCIS, no extensive intraductal (i.e. DCIS) component, pathologically node negative, sentinel node biopsy or axillary lymph node dissection.  The article goes on to loosen some of those criteria in defining a "cautionary" group for whom APBI may be considered, as well as defining a group of patients for whom APBI is "unsuitable". 

There are also practical considerations such as how close the tumor was to the skin or other organ that might be better off if they avoid the heavy and fast dose rate used in APBI.

Some radiation oncologists are more favorably inclined toward APBI than others and use of these guidelines, especially for the "cautionary" group,  will vary. 

kira1234

I had the Contra done last year. I must say I was very happy with it. I was concerned with the heart issue, so was glad I was able to do it. I had to wait for my path report before my BS said I was a candidate for it.

One thing I would recommend is use a radiologist who has done this procedure many times. For me this was the most important thing. Redsox has a report that is well Worth the read. As with any new procedures there are always risks, and I for one want to know as much  as possible before having it done.

If you have any questions you are more than welcome to PM me.

sweetcorn

My RO recommended the Brachytherapy radiation treatments prior to the decision to have chemo.  Does anyone know if the long wait between lumpectomy (February 7) and after chemo will affect the decision for the brachytherapy?  My chemo is over with on Wednesday and then my appt. with the RO is on July 27.

Jane

kira1234

sweetcorn, I don't believe you would be able to do it after chemo. The surgery site would be healed by now. Good luck I hope I'm wrong.

sweetcorn

Kira1234, You are probably right.. I will try to get psyched up for the long, long treatment...

Thanks, Jane

LuvRVing

Sweetcorn - in order to do Mammosite, the surgeon must be able to insert a balloon that gets filled with saline into the lumpectomy cavity.  It is usually done at the time of or soon after the lumpectomy. I highly doubt it could be done after chemo.

Michelle

kira1234

Michelle, Nice to see you posting. How are you doing?

sweetcorn

actually, she wasn't able to insert the balloon at the time of surgery, because of my "size," if I remember correctly, so the RO was going to do the other procedure, inserting the tiny catheters?  What is that called?  Maybe they can still do that?

Jane

kira1234

I've never heard of that procedure. Hopefully someone will come along with some knowledge.

redsox

That other procedure for doing APBI is called "multi-catheter". It uses multiple smaller catheters rather than one big one in the cavity used in Mammosite.   Another method for doing APBI is Intensity Modulated Radiation Therapy (IMRT) which is external beam radiation therapy.  If you are still a candidate for APBI, you could ask about those techniques.

peachy-pie

I am having my Mammosite catheter put in 9 days after my lumpectomy,  that is as long as my path report comes back with results my doctor expects.  The report should be in tomorrow,    I'll let you all know how I make out.    I know I won't be happy if I find out I have to go through 6 weeks of radiation instead of 5 days.   But i'll have to do what I have to do.   I was told I probably would not need Chemotherapy,  I hope they're right.   Does anyone know what determines the need for Chemo?   I always thought everyone needed it if they had cancer. 

peachy-pie

Just got the call from my BS and was told my margins are clear!!!   I will have the Mammosite catheter inserted tomorrow and start my radiation treatments on Monday!   I am so happy!

cycle-path

Hurray, peachy-pie! Keep us updated!

peachy-pie

I sure will.      Going at 2:30pm to have the catheter put in,  nervous about it,  hope it doesn't hurt and is not too uncomfortable.   I will keep you posted!  

peachy-pie

Catheter is in!   I didn't feel a thing,  but it sticks out & is bulky under my arm which is uncomfortable.   I have to sponge bathe for the next 8 days,  and I cannot sleep on my right side.    Hopefully this week will go by quickly.    Path report said my tumor was 2.2cm which moved me up to a stage 2.   Lymph nodes were clear thank God.   But now I was told I would need chemo.   Not looking forward to that,  but something I have to do.    Hoping maybe I won't lose my hair. 

cycle-path

peachy-pie, someone told me that it might be nice if, during the time you can't shower, you make an appointment to have your hair shampooed once or twice. I thought this sounded like a good idea. To me the idea of not being able to shower was worse than anything!

peachy-pie

That is funny you told me that cycle path!   I had a friend tell me that today!   and what a great idea!!!   I would've never thought of that myself.    I have a hair appt Saturday,  but next week maybe I can find a salon where i'll be staying during my treatments to get my hair washed.   I think not being able to bathe is going to be the worst thing about this.   I am used to getting a nice hot shower every morning!