Has anyone had balloon-catheter internal radiation?

Johns Hopkins will not participate in clinical trials on brachytherapy. I have always wondered why. I was given the choice, but chose whole breast radiation therapy for my left side. Two years out and so far no regrets or problems. Much of the data for whole breast radiation is very old. With newer machines it would be interesting to compare the data from whole breast radiation from 10 and 20 years ago. I am inclined to believe that it has improved significantly causing fewer issues.

My understanding is that Mammosite is still experimental and not standard of care.

Theyve been doing it overseas for longer than the US.  The data and study from 2007-8 is pretty outdated - and was done on women with INVASIVE breast cancers, over the age of 66 who were on Medicare - a more random study would tell so much more.  And 4 or 5 years is a long time in the medical world.....a lot has happened.  Insurance would not cover it if it were experimental.  There is no "latest data" that is controversial, except this one study.  

I too will get a lot of questions answered on Friday when I meet with the RO.  Itll be great to make an informed decision that is right for me....hard to decipher things on the net  

The findings from the San Antonio Breast Cancer Symposium were concerning enough for the folks at breastcancer.org, that this is what they said:

Brachytherapy May Not Be as Effective as Whole-Breast Radiation in Reducing Recurrence Risk

Radiation therapy commonly is used after lumpectomy to treat early-stage breast cancer and reduce the risk of the cancer coming back (recurrence). Brachytherapy is a newer form of radiation therapy and an alternative to traditional whole-breast external beam radiation therapy. Brachytherapy delivers a higher dose of radiation to a smaller area of the breast over a shorter period of time compared to traditional (external beam) radiation therapy. Doctors sometimes refer to brachytherapy as accelerated partial breast irradiation (APBI).

Brachytherapy use has been increasing steadily since it was first approved by the U.S. Food and Drug Administration in 2002. Still, many experts have been concerned about the increase because there aren't many long-term studies that show that brachytherapy works as well as traditional radiation therapy.

Now results from a large study suggest that brachytherapy may not be as effective as whole-breast radiation therapy at preventing breast cancer recurrence. Women in the study who got brachytherapy after lumpectomy for early-stage breast cancer were nearly twice as likely to later have a mastectomy because of cancer recurrence compared to women who got traditional whole-breast radiation therapy.

The results were presented at the 2011 San Antonio Breast Cancer Symposium.

Traditional external beam radiation therapy aims cancer-destroying energy at the whole breast or to the area of the breast where the cancer was. The source of the radiation is outside the breast, which is why it's called "external beam." Many studies have shown the long- and short-term effectiveness of external beam radiation therapy. The drawbacks of traditional radiation therapy include daily trips to the hospital for treatments -- typically 5 days a week for 4 to 6 weeks. Traditional radiation therapy also has a large field and may expose healthy tissue, such as the heart and lungs, to radiation.

To overcome the drawbacks of traditional radiation therapy, doctors have developed different ways to deliver radiation. Brachytherapy places the radiation source inside the breast. Two types of brachytherapy are used right now and another is experimental. They are:

• Multi-catheter internal radiation, also called interstitial needle-catheter brachytherapy. This approach uses radioactive "seeds" to deliver radiation directly to the area where the cancer was. The seeds are placed in very small tubes (catheters) that are stitched into place under the skin. The seeds are left in the tubes for a few hours or a few days. You remain in the hospital during treatment. Once the treatment is completed, the seeds, tubes, and stitches are removed and you go home.
• Balloon internal radiation, known by the brand name MammoSite. This approach places a special tube with a balloon on one end in the breast where the cancer was. The tube comes out of the skin through a small hole. The tube and balloon are placed either during lumpectomy or afterward in a surgeon's office. During each treatment, a machine places a radioactive seed into the center of the balloon for 5 to 10 minutes -- just long enough to deliver the required dose of radiation. After the seed is removed, you may leave the treatment center. A total of 10 treatments are usually given over 5 days. That means two treatments per day, about 6 hours apart. When the final treatment is done, the balloon and tube are removed through the small hole in the skin.
• 3-D conformal external beam radiation (3DCRT). This experimental approach starts with a planning session (simulation). A special MRI or CAT scan of the breast is done and is used to map out small treatment fields for the area at risk. The type and distribution of radiation is designed to maximize the dose to the area that needs to be treated and avoid or minimize radiation to tissue near the area. The radiation is delivered with a linear accelerator, the same machine used in traditional external radiation, twice a day for 1 week.

To see if brachytherapy was as good as traditional whole-breast radiation, researchers reviewed the treatment histories and outcomes of more than 130,000 women diagnosed with early-stage breast cancer who had lumpectomy to remove the cancer. All the women had radiation therapy after surgery -- either traditional whole-breast radiation therapy or brachytherapy (multi-catheter internal radiation therapy or MammoSite).

The researchers looked to see how many women had mastectomy during the 5 years after lumpectomy and radiation:

• 4% of women treated with brachytherapy after lumpectomy later had mastectomy.
• 2.2% of women treated with whole-breast radiation therapy later had mastectomy.

Overall, complications from brachytherapy were much higher than with traditional whole-breast radiation therapy:

• 9.6% of women treated with brachytherapy needed hospitalization during or after treatment compared to 5.7% of women treated with whole-breast radiation therapy.
• 8.1% of women treated with brachytherapy developed an infection related to treatment compared to 4.5% of women treated with whole-breast radiation therapy.

Other treatment complications -- such as rib fracture, breakdown of fat in the breast (fat necrosis), breast pain, and inflammation in the lungs -- were more likely among women treated with brachytherapy.

Some of the higher complication rates may be because brachytherapy requires a device to be implanted under the skin.

Besides being a quicker way to deliver radiation therapy, many doctors like brachytherapy because the radiation delivery is focused, potentially avoiding exposing healthy tissue to radiation. Even though brachytherapy is becoming more popular, experts continue to warn that right now there's not enough evidence to confidently conclude that brachytherapy is as effective and safe as traditional whole-breast radiation therapy.

The results of this study suggest that this caution makes sense. Still, some experts feel that the results reflect early use of brachytherapy and that doctors are now better at using brachytherapy more effectively and safely. Several very large, well-designed studies are currently being done to evaluate the short-term and long-term effectiveness and safety of brachytherapy compared to traditional whole-breast radiation therapy. It will be several years before the results are available.

If you've been diagnosed with early-stage breast cancer, are having lumpectomy, and will be receiving radiation therapy after surgery, you and your doctor may consider brachytherapy as an alternative to traditional external beam radiation therapy. Perhaps the daily trips to the treatment center would be a burden because of distance. Talk to your doctors about their experience with brachytherapy compared to traditional radiation therapy. You also may want to ask about their familiarity with the technical aspects of delivering brachytherapy since placement of the catheters or balloon is a skill that can take some time to master.

The Breastcancer.org Radiation Therapy section has more information on both traditional external beam radiation therapy and brachytherapy

Sorry - not trying to be argumentative either.....just saying that a study such as the SA one - which is not random.....is hardly enough to base claims that brachy is "experimental".  

Glad external rad worked out for you without SE.  Thats what we all want, the best choice for our individual situations.....bc they are as different as the options available.   

I think Id rather trust a physician who is familiar with both types of radiation treatment, and is up on the latest stats on both, and the side effects.  Not some study from 4 years ago that was done on a select group of people with a different type of cancer & age group.  

Regarding differences in sample population characteristics... That is always a problem in clinical trials and often makes it difficult to extrapolate relevant information. That's where a good, experienced doctor comes into play. They look at the available data and then try to decide if it is relevant to you.

NCCN guidelines also state that it should be offered to patients with low risk of recurrence and also noted that It be performed only as part of perspective trial.

Talked to a doc friend of mine, radiologist - who mentioned one interesting fact....seed radiation therapy or brachy therapy for prostate cancer has been around since 1911.....its not a new idea - just relatively new to breast cancer.  Got lots of great info from him....

Infobabe

Will send up extra prayers for you tomorrow.  I hope the Path. report is all clean!!!!!

I had oral surgery early Feb. this year (5 stitches in gum above the tooth area)  Sure feels better now than it did before the surgery..  Good to have it as history, right?

Again will pray for you and the your medical team that they will do what is best for you!!!!!!

{{{{{{{{HUGS}}}}}}

Vickie