Radioactive 'Seed' Rx Helps Women With Implants Fight Breast Cancer
MONDAY, Dec. 1 -- Women who have had their breasts augmented with implants and are later diagnosed with early-stage breast cancer may be treated successfully with a partial-breast radiation treatment known as brachytherapy, according to an Arizona physician and researcher.
"It's such a challenge to take care of these augmented women," said Dr. Robert Kuske Jr., a Scottsdale radiation oncologist and clinical professor of radiation oncology at the University of Arizona Health Sciences Center, Tucson.
Kuske was expected to present the study Monday at the Radiological Society of North America's annual meeting, in Chicago.
In brachytherapy, the physician watches via a computer as tiny radioactive "seeds" are guided into place in the breast through small plastic tubes. Once they are in place, the seeds emit high doses of radiation in short bursts. The treatment takes five days.
As Kuske explained, other therapies such as external beam radiation can be performed on women with augmented breasts who first undergo a lumpectomy. However, beam radiation carries a risk of scar tissue forming around the implant. This complication, called capsular contracture, can be both painful and disfiguring.
So, Kuske offered brachytherapy instead to 69 women who had had their breasts augmented before their cancer diagnosis. These women also did not want to undergo a mastectomy and breast reconstruction, preferring lumpectomy instead. Brachytherapy can be given in higher doses to a small, targeted area of the breast after a lumpectomy to remove the tumor.
None of the 69 patients have had a recurrence of the cancer during a follow-up that ranged from a half a year to 5.5 years, with a median follow-up of 16 months, Kuske said.
Regarding the women's post-treatment appearance, "95 percent had excellent results," according to Kuske. "You can't even tell the breast has been treated." Five percent got "good" results. None of the patients developed capsular contracture, he said.
Seed therapy has been used for years to treat prostate cancer successfully, Kuske noted, and was even used years ago to treat breast cancer. But the technology has improved greatly, said Kuske, who also serves as a consultant for Nucletron, a radiotherapy company, and Cianna Medical, which makes a breast brachytherapy device.
The treatment may appeal to women who don't want to have their augmented breast removed, said Dr. Christy Russell, associate professor of medicine at the University of Southern California's Norris Cancer Center in Los Angeles and chair of the American Cancer Society's Breast Cancer Advisory Committee.
Women with augmented breasts who develop breast cancer can undergo mastectomy and reconstruction, she said, but some women want to keep the augmented breast instead.
"It's a fine study," Russell said. "But his follow-up is too short, and there are too few patients." More study is needed, she said.
Longer follow-up is definitely needed, agreed Dr. Nayana Vora, professor of radiation oncology, City of Hope Comprehensive Cancer Center, Duarte, Calif. "Most capsular contracture happens within two years after radiation therapy," she noted.
Many women, she said, will still opt for mastectomy and reconstruction. But the brachytherapy option may be an alternative for those who don't want to give up their augmented breasts.
But, Vora stressed, this is only for women with small tumors, probably less than 3 centimeters in diameter. "I would not offer this to the patient with a larger tumor," she said, because the radiation oncologist would need to treat more of the breast, thus increasing the risk of capsular contracture.
To learn more about brachytherapy, visit the American Cancer Society.
Posted: December 2008
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