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Brachytherapy Provides Benefits Over Radiotherapy for Breast Cancer in Women With Implants: Presented at RSNA

By Ed Susman

CHICAGO -- December 2, 2008 -- Brachytherapy appears to be safe and maintains a good cosmetic appearance in women with breast implants who require breast cancer treatment, researchers reported here at the Radiological Society of North America (RSNA) 94th Annual Meeting.

Presently, women with breast cancer and implants who undergo breast conserving therapy and whole breast irradiation face a high risk of capsular contraction. Until now, the alternative has been to perform skin-sparing mastectomy with axillary dissection and implant exchange, said researcher Robert R. Kuske, Jr., MD, Advanced Providers of Breast Irradiation Clinic, Scottsdale, Arizona.

However, in his oral presentation on December 1, Dr. Kuske said that in a series of 35 women followed for a median of 26 months, 91% rated their cosmetic appearance as excellent (meaning, there was no difference in cosmesis between the women's breasts before and after treatment) and 9% rated it as very good (meaning, there was a slight asymmetry).

There have been no local breast cancer recurrences in these patients, all of whom had early-stage breast cancer with fewer than 4 lymph nodes involved per patient.

The brachytherapy regimen lasts 5 days compared with the standard 6.5-week session for standard whole-breast irradiation.

In Dr. Kuske's procedure, patients underwent lumpectomy to remove lesions smaller than 3 cm; they had fewer than 4 lymph nodes involved. The women were aged 50 years on average.

Following the surgery to excise the tumour, Dr. Kuske used a template to compress the breast tissue above the implant. This same template is used for mammograms in women who have implants. The operator pulls the breast tissue out from the implant and then compresses the tissue between the templates. The breast is then imaged with computerised tomography (CT).

Using the CT image to guide the process, the radiologist then inserts brachytherapy capsules into the breast through catheters inserted into a series of predrilled holes that are used to guide the needles and to avoid puncturing the implant.

Dr. Kuske said that he has not had a single capsule puncture using this procedure. The radiation dose was 34 gray in 10 twice-daily fractions with a high dose of iridium-192. The treatments were at least 6 hours apart.


[Presentation title: Breast Brachytherapy Improves Cosmetic Outcome and Reduces the Risk of Capsular Contracture in Breast Conservation Therapy for Women With Breast Cancer in the Presence of Augmentation Mammoplasty. Abstract SSC19-02]

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