Omar Bennett
Balloon radiation therapy, also known as brachytherapy, is a form of accelerated partial breast irradiation used to treat breast cancer. It involves placing a small, soft balloon attached to a thin tube (catheter) into the lumpectomy cavity, which is then inflated with a saline solution or filled with a radioactive material such as 99mTc or HDR 192Ir. This treatment method has been shown to be effective in reducing local recurrence rates and is often considered an attractive option due to its shorter treatment times, reduced travel time for patients, and improved cosmetic outcomes compared to traditional external beam radiation therapy. Patient factors such as breast size, tumor location, age, and prior treatment history are considered when determining eligibility for balloon radiation therapy.
| Characteristics | Values |
|---|---|
| Tumor size | Less than 3 cm in maximum dimension |
| Tumor type | Pure ductal carcinoma in situ |
| Tumor stage | Stage 0, I, or II |
| Age | Below 50 years |
| Ductal carcinoma | More than 25% |
| Exiguous margins | Less than 1 cm |
| Local aggressiveness | High |
| Cancer spread | Cancer has not spread to other parts of the body |
| Prior radiation therapy | Considered |
| Breast size | Considered |
| Tumor location | Considered |
| Preexisting conditions | Considered |
| History of collagen vascular disease | Considered |
| Prosthetically augmented breasts | Considered |
| Margin status | Considered |
| Presence of extensive intraductal component | Considered |
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What You'll Learn
Balloon brachytherapy as an alternative to external beam radiation
Breast cancer treatment involves a multi-disciplinary approach, with radiation therapy playing a key role. Breast-conserving surgery has been an option for women with early-stage breast cancer for over two decades. Multiple trials have demonstrated the efficacy of breast-conserving surgery followed by radiation therapy.
External Beam Radiation Therapy (EBRT)
The most common type of radiation therapy for women with breast cancer is External Beam Radiation Therapy (EBRT). A machine outside the body focuses the radiation on the affected area. If you have had a mastectomy and no lymph nodes had cancer cells, radiation will be focused on the chest wall, the mastectomy scar, and the places where any drains exited the body after surgery. If you had BCS, you will most likely have radiation to the entire breast. An extra boost of radiation to the area in the breast where the cancer was removed is often given if there is a high risk of the cancer returning.
Balloon Brachytherapy
Breast brachytherapy is a type of internal radiation therapy that involves placing a sealed radioactive source in or near a tumour to destroy the cancer cells. It is used to treat early-stage breast cancers that have not spread to other parts of the body. The treatment can be combined with conventional external beam radiation therapy (EBRT).
Temporary 99mTc-filled balloon implants could represent an attractive option for adjuvant radiotherapy in breast cancer. The technique supplies an adequate boost dose, with spatial dose distribution contained within the tumour bed surroundings, and its use is justified by its availability and economic viability. Balloon brachytherapy is an acceptable alternative to external beam radiation for selected operable breast cancers.
The MammoSite balloon brachytherapy is a 5-day targeted radiation therapy that can be used following a lumpectomy. A small soft balloon attached to a thin tube (catheter) is placed inside the lumpectomy cavity through a small incision in the breast. The balloon is inflated with a saline solution so that it fits snugly into the cavity. A radiation oncologist will take images of the balloon catheter and determine the radiation dosage. During radiation therapy, the portion of the catheter that remains outside the breast is connected to a computer-controlled High Dose Rate (HDR) machine that inserts a radiation "seed" to deliver the targeted therapy.
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Patient eligibility for balloon brachytherapy
Firstly, balloon brachytherapy is typically considered for patients with early-stage breast cancers that have not spread to other parts of the body. Patients with Stage 0, I, or II tumours, and a single tumour less than 3 cm in maximum dimension, are generally eligible for this treatment.
Secondly, patient-specific factors are taken into account. These include breast size, tumour location, history of prior radiation therapy, pre-existing conditions such as collagen vascular disease, age, and whether the patient has prosthetically augmented breasts.
Thirdly, tumour characteristics play a role in determining eligibility. For instance, patients under 50 years of age, with specimens showing more than 25% ductal carcinoma in situ, exiguous margins of less than 1 cm, and a high degree of local aggressiveness, may be suitable candidates for balloon brachytherapy.
It is important to note that not all patients with breast cancer are suitable for balloon brachytherapy. The suitability of this treatment depends on the specific circumstances of each patient and their cancer. A doctor will be able to advise on the most appropriate treatment plan based on an individual's unique situation.
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Radiation dosage and safety procedures
Radiation therapy is a treatment with high-energy rays or particles that destroy cancer cells. The type of radiation therapy used depends on the stage of breast cancer and other factors. Radiation therapy can be used after breast-conserving surgery (BCS) to help lower the chance that cancer will return in the same breast or nearby lymph nodes. It can also be used after a mastectomy, especially if the cancer was large or if cancer is found in many lymph nodes. If cancer has spread to other parts of the body, radiation therapy can be used to treat those areas as well.
Breast-conserving surgery is often followed by breast irradiation. A radiotherapy boost in the area is recommended for patients under 50, with ductal carcinoma in situ, exiguous margins of less than 1 cm, and aggressive local tumors. Postoperative radiotherapy is necessary for treating ductal carcinoma in situ with breast-conserving surgery.
Balloon-based adjuvant radiotherapy is a type of temporary brachytherapy that uses a 99mTc-filled balloon implant to deliver a boost dose of radiation directly to the tumor bed. This technique is economically viable and readily available in nuclear medicine facilities. The 99mTc-filled balloon implant technique involves inserting a small catheter (tube) into the space left after breast-conserving surgery. The end of the catheter inside the breast is expanded like a balloon to stay securely in place during treatment. The other end of the catheter remains outside the breast. Radiation sources, often in the form of pellets, are placed through the tube into the balloon for a short duration before being removed.
The radiation safety procedures for high-activity 192Ir sources used in HDR brachytherapy are stricter than those for 99mTc generators due to their higher activity and shorter half-life. 192Ir sources require special considerations during acquisition, transportation, and substitution, making management more complex. Conventional radiotherapy protocols typically involve 25 sessions of 1.8-2.0 Gy per day, with two parallel opposed fields of 6 MV, administered 5 days a week for 45-60 days, resulting in accumulated doses of 50 Gy covering the mammary gland tissue. In contrast, HDR 192Ir brachytherapy achieves maximum exposure in sessions of 20-25 minutes, while the 99mTc-filled balloon technique requires 24 hours.
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Tumor size, location, and other factors
Tumor size is a significant consideration when evaluating candidates for balloon radiation therapy, also known as brachytherapy. Brachytherapy is generally recommended for patients with early-stage breast cancers that have not spread to other parts of the body. Specifically, patients with Stage 0, I, or II tumors, and a single tumor measuring less than 3 cm in maximum dimension, are considered potential candidates for accelerated partial breast radiation therapy, which includes balloon brachytherapy.
The location of the tumor is another important factor. Brachytherapy is often used after a lumpectomy, where a small, soft balloon is placed inside the lumpectomy cavity to deliver radiation directly to the tumor bed. This technique is known as intracavity brachytherapy or balloon brachytherapy. The placement of the balloon catheter in the lumpectomy cavity allows for precise radiation delivery, reducing the radiation exposure to surrounding healthy tissues in the breast, ribs, and lungs.
In addition to tumor size and location, other factors are considered when determining eligibility for balloon radiation therapy. Patient factors such as breast size, history of prior radiation therapy, pre-existing conditions, age, and patient preference are also taken into account. Pathological factors, including margin status, the presence of an extensive intraductal component requiring multiple surgical excisions, and the degree of local aggressiveness, are also considered.
It is important to note that not all breast cancer patients are suitable candidates for brachytherapy. The suitability of balloon radiation therapy depends on a comprehensive evaluation of these factors, and decisions regarding treatment options should be made in consultation with a medical professional.
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Side effects and cosmetic outcomes
Radiation therapy is a common treatment for breast cancer, and it can be used in several situations. It is often used after breast-conserving surgery (BCS) to prevent the cancer from returning in the same breast or nearby lymph nodes. It is also used after a mastectomy, especially if the cancer has spread to the lymph nodes.
Balloon brachytherapy is a form of adjuvant radiotherapy that can be used as an alternative to external beam radiation for selected operable breast cancers. The treatment time is shorter than that of conventional radiotherapy, which usually lasts from one to six weeks. The shorter treatment time of balloon brachytherapy allows working women and those who live far from radiation centers to opt for breast conservation rather than mastectomy.
Side Effects
The side effects of radiation therapy for breast cancer can be early or late. Early side effects appear towards the end of treatment or within a few weeks of completing it, while late side effects can appear six months to a year after treatment completion. The side effects can be uncomfortable, but they are usually less severe than those experienced with chemotherapy.
The most common early side effects of radiation therapy are skin irritation and fatigue. As treatment progresses, the skin on the breast or chest that is repeatedly exposed to radiation may become dry, red, and irritated. It may even peel. Fatigue typically occurs towards the end of treatment, but it is usually mild. The skin may also not return to its normal color and may remain tanned in the areas exposed to radiation. Moisturizing can help fade this discolouration. Radiation can also cause the exposed areas of the breast or chest wall to tighten or harden, resulting in reduced softness and flexibility.
Other side effects include pain, hair loss in the affected area, and swelling of the breast tissue. There is also a risk of lymphedema, or swelling of the arm or upper body, if lymph nodes have been removed from the neck, arm, or torso. Lymphedema can be treated with surgery in many cases. Radiation therapy can also cause a sore throat, especially if lymph nodes in the neck are being treated. Pneumonitis, a rare side effect, may cause coughing or shortness of breath and is caused by irritation to the lung just under the ribs on the treated side.
There is a very low risk of developing a secondary cancer due to radiation exposure, but the benefits of treating the current cancer usually outweigh this risk.
Cosmetic Outcomes
A study on balloon brachytherapy reported that patients quickly adjusted to the breast distension caused by the balloon and had a high acceptance of the procedure. The cosmetic outcome was rated as high, with 90% of participants reporting an overall good or excellent cosmetic outcome.
However, some side effects of radiation therapy can impact cosmetic outcomes. For example, the skin on the breast or chest may not return to its normal color, and there may be persistent tanning in the areas exposed to radiation. Radiation can also cause tightening or hardening of soft tissues, affecting the softness and flexibility of the exposed areas.
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Frequently asked questions
Balloon radiation therapy, also known as balloon brachytherapy, is a form of accelerated partial breast irradiation. It involves placing a small soft balloon attached to a thin tube (catheter) inside the lumpectomy cavity. The balloon is inflated with a saline solution and remains inflated during the treatment period. The catheter is then connected to a computer-controlled High Dose Rate (HDR) machine that delivers the radiation.
Balloon radiation therapy delivers radiation from inside the lumpectomy cavity, targeting the area where cancer is most likely to recur. This is in contrast to whole-breast radiation, which is delivered from outside the breast. Balloon radiation therapy allows for a higher daily dose of radiation to be administered over a shorter period, typically five days.
Candidates for balloon radiation therapy are typically patients with early-stage invasive breast cancer who have undergone breast-conserving surgery (BCS). Patient factors such as breast size, tumour location, age, and pre-existing conditions are considered when determining eligibility for balloon radiation therapy. Tumour size and location can also impact eligibility, as larger or more advanced tumours may not be suitable for this treatment.
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