How brachytherapy can be used to treat breast cancer

Dr. Cristina Gutiérrez Dr. Cristina Gutiérrez is the clinical head and coordinator of the Brachytherapy unit at Hospital Duran i Reynals in Barcelona. In this video, Dr. Gutierrez talks about breast cancer and brachytherapy as a treatment of choice for breast conservation therapy.

Advancing Breast Cancer Care: Brachytherapy – a Promising Solution for Breast-Conserving Treatment

Brachytherapy to treat breast cancer patients

Breast cancer remains a significant concern, impacting the lives of countless individuals worldwide. Over the years, advancements in treatment options and radiation therapy for breast cancer have emerged. This includes the remarkable technique of breast brachytherapy.

Dr. Gutierrez mentions the pivotal role of brachytherapy in breast cancer management, shedding light on its effectiveness in targeting cancer cells, minimizing radiation exposure, and preserving breast tissue. She highlights its benefits as a key component of breast-conserving therapy, its implications in cancer recurrence cases, and its integration within the field of radiation oncology.

What is Brachytherapy?

Brachytherapy is an internal radiation therapy used to treat cancer and other conditions. It involves the placement of radioactive material, such as seeds or pellets, directly inside or near the tumor. Unlike external beam radiation therapy, which delivers radiation from outside the body, brachytherapy delivers a high dose of radiation directly to the tumor bed, minimizing exposure to surrounding healthy tissues. This targeted approach allows for precise and effective treatment while minimizing side effects.

Depending on the type and stage of cancer, brachytherapy can serve as a primary treatment or in combination with other therapies such as chemotherapy, hormonal therapy, and external radiation therapy. It is commonly used in the treatment of prostate, cervical, or breast cancer as well as skin cancer.

The Role of Brachytherapy in Radiation Oncology

Minimizing Radiation Exposure

Radiation exposure is a critical consideration in cancer treatment. Brachytherapy’s localized approach minimizes radiation exposure to surrounding healthy tissues. By integrating brachytherapy into radiation oncology practices, experts can tailor treatment plans and reduce the potential for long-term side effects. This collaborative effort between radiation oncologists and breast surgeons ensures comprehensive care that prioritizes patient well-being.

The Role of Brachytherapy in Targeted Radiation Therapy

Precision in Cancer Treatment

In breast cancer cases, the tumor is typically removed, leaving a risk area of just a centimeter or two surrounding the surgical site. Because this region remains at a higher risk of tumor development, precision in treatment is paramount.

With breast brachytherapy, the radiation oncologist can deliver highly targeted radiation therapy directly to the tumor bed through the insertion of tubes called applicators. The therapy aims to eradicate cancer cells while effectively minimizing damage to healthy tissue. This internal radiation therapy technique proves particularly valuable in the treatment of invasive breast cancer, where localized treatment is essential for optimal outcomes.

Brachytherapy in Breast-Conserving Therapy

Enhancing Breast Conservation

For women with early-stage breast cancer, breast-conserving therapy, which entails lumpectomy (tumor removal), has gained prominence as an effective treatment approach, allowing women to preserve their breasts.

Numerous randomized trials and meta-analyses have established similar outcomes for mastectomy and breast-conserving therapy (BCT).1–2 Combining lumpectomy with radiation reduces the risk of breast tumor recurrence (IBTR) on the same side 1–3 and improves overall survival.2–3

However, while whole breast radiation is generally well-tolerated, it is not without risks. The potential for late effects can be radiation pneumonitis, cardiotoxicity, and the development of secondary malignancies.

Accelerated partial breast irradiation with brachytherapy

Accelerated partial breast irradiation (APBI) is an alternative to whole breast radiation for appropriately selected women with early-stage breast cancer.

With APBI, radiation is delivered only to the breast tissue immediately adjacent to the initial tumor site, typically a 1–2 cm margin of breast tissue surrounding the surgical cavity.

APBI can be delivered with a number of techniques.

The technique that has been studied with the longest follow-up is interstitial brachytherapy, in which multiple catheters are inserted in the breast.

External beam radiation therapy is another method of APBI delivery. However, due to patient setup and movement uncertainties, a larger margin of breast tissue must be targeted for adequate treatment of the at-risk area. Brachytherapy is the preferred approach for APBI.

Breast-conserving therapy has gained prominence as an effective treatment approach for breast cancer. In this context, brachytherapy is pivotal in delivering radiation therapy to the tumor bed, ensuring that the patient receives precise and focused treatment. This technique preserves mammary tissue while achieving comparable outcomes to whole breast radiation therapy, empowering breast cancer patients to preserve their breasts and self-confidence.

Brachytherapy as a Solution for Cancer Relapse

Addressing Cancer Recurrence

Cancer relapse poses a significant challenge for patients and healthcare providers alike. Historically, mastectomy was the standard approach for recurrent breast cancer cases.

Certainly, undergoing a mastectomy can be highly traumatic for patients, and it may not necessarily improve their survival outcomes. However, brachytherapy has emerged as a viable alternative, offering comparable results while sparing patients from breast removal’s physical and emotional toll.

Dr. Gutiérrez shares with us that promising evidence from studies conducted by the European Brachytherapy Group, demonstrated that a second surgery utilizing brachytherapy to remove the tumor yields comparable results to mastectomy.

One of the most significant benefits is that the patient retains her breast, which is paramount in body image, self-confidence, and overall well-being. This groundbreaking approach to breast cancer treatment provides a ray of hope for patients, offering effective results without the need for complete breast removal.

Shaping the Future

Brachytherapy’s Impact on Breast Cancer Care

As breast cancer treatment continues to evolve, the integration of brachytherapy marks a significant milestone. The collaboration between radiation oncology and breast surgery specialists has allowed for innovative techniques that preserve breast tissue, offer targeted radiation treatment, and enhance the overall well-being of breast cancer patients.

Breast brachytherapy’s integration within breast-conserving therapy and its role in addressing cancer relapse showcase its potential to revolutionize breast cancer care. By minimizing irradiation exposure and offering comparable outcomes to traditional approaches, brachytherapy has reshaped the field of radiation in cancer care. As we continue to prioritize personalized and effective treatment, the collaboration between experts in radiation oncology and breast surgery paves the way for a brighter future for breast cancer patients worldwide.