Originally created 02/08/02

Radioactive 'seeds' cuts radiation time for breast cancer patients



CHICAGO -- Learning she had breast cancer was bad enough for 40-year-old Miriam Norton. Almost as troubling was the burden of six weeks of radiation treatment.

The mother of two young children didn't like the idea of exposing her entire breast to radiation and feared the disruption and mental anguish involved with more than a month of therapy.

"It was the time involved, and trying to be a mom and trying to have a normal life," said Norton of Glen Ellyn, Ill.

Then she learned about brachytherapy, a radiation alternative more commonly associated with prostate cancer treatment. A few breast cancer doctors have been using it as a follow-up to lumpectomy - removal of only the tumor - and recent studies show it's effective.

Unlike standard external radiation, brachytherapy works from the inside, with radioactive "seeds" injected into the breast at the site of the excised tumor, where cancer is most likely to recur.

Best of all, breast brachytherapy requires about four or five days of treatment instead of six weeks or more. And Norton, like about 70 percent of U.S. women diagnosed with breast cancer, was eligible because her tumor was small and caught early.

She had the procedure last May.

"I was in, I was out, it was one week - and then I got on with my life," said Norton, now 42. "It was wonderful."

Brachytherapy - brachy means "short" in Greek - refers to the short distance between the radiation source and the targeted tissue.

Dr. Robert Kuske, who treated Norton at the University of Wisconsin in Madison, says that in 1991 he was the first doctor to perform breast brachytherapy in this country. He does the procedure on about 100 patients a year, but it is not widely available. Many patients have never heard of it and some doctors consider it experimental.

Proponents think that's about to change. Two recent studies involving at least five years of data on more than 200 women suggest breast brachytherapy is as effective as standard radiation at preventing cancer recurrence. In addition, the U.S. Food and Drug Administration has been asked to approve a new device called MammoSite. That would make brachytherapy easier, said Dr. Krystyna Kiel, a Northwestern University radiation oncologist with a waiting list of patients who want the procedure.

Kiel has only used brachytherapy a few times in the past five years but says she'd likely do a treatment each week if the new device is approved.

The American Cancer Society estimates that 203,500 U.S. women will be diagnosed with breast cancer this year. About 70 percent will be potential candidates for lumpectomies, and thus brachytherapy, because their tumors are early stage and small, said Dr. LaMar McGinnis, the society's senior medical consultant.

Many, however, will choose disfiguring mastectomies - which generally don't require radiation - simply because they can't afford or fear the time required for standard radiation, McGinnis said.

He said brachytherapy holds great promise "because of the convenience for patients and the hopes of getting more patients to choose breast conservation therapy."

McGinnis noted that some doctors worry that patients who undergo the procedure might also have undetected tumors elsewhere in their breast that would be treated with standard radiation but not with brachytherapy.

Dr. Beryl McCormick, a breast cancer specialist at Memorial Sloan-Kettering Cancer Center, said brachytherapy probably will prove to be best for patients 55 and older whose cancer is less likely to recur.

McGinnis said more long-term data is needed to show brachytherapy's effectiveness. Occasional side effects, including tissue hardening or reddening, probably will be avoided as more doctors become skilled at the technique, he said.

More than 100 doctors attended the first annual breast brachytherapy "school" for three days a few weeks ago in New Orleans. Kuske was on hand to teach the procedure.

The high-dose method Kuske uses involves temporarily inserting an average of 19 spaghetti-thin plastic catheters into the cavity where the tumor was removed.

During twice-daily treatments, radioactive metal seeds about the size of rice grains are injected, then retracted through the catheters, which are attached by a cable to a radiation machine. Women can return home between treatments and the catheters are removed at week's end.

Medicine numbs the breast during the procedure, which takes about an hour including preparation time, Kuske said.

The MammoSite device awaiting FDA approval involves inserting a single catheter into the breast, attached to a tiny balloon that is inflated and filled with radiation. Manufacturer Proxima Therapeutics Inc. says eight months of data show the device is safe, though whether patients remain cancer-free long-term is unknown.

On the Net:

American Brachytherapy Society: http://www.americanbrachytherapy.org

American Cancer Society: http://www.cancer.org