Brachytherapy: The One and Done Breast Cancer Treatment

A radiation therapy that’s long been used to treat prostate cancer is now being used successfully on breast-cancer patients.

Brachytherapy: Following tumor removal, titanium seeds filled with radioactive palladium are placed around the tumor cavity using a series of tiny hollow needles – about the size used to draw blood. The seeds are deposited and left in place around the edges of the cavity, where the risk of cancer spreading is highest.

The new brachytherapy procedure, which involves placing tiny radioactive pellets in the space left by a removed tumor, is being done at the Bon Secours Cancer Institute at DePaul in Norfolk. The institute is the only cancer center in the southeastern United States – and one of just three in the country – to offer the new treatment.

Brachytherapy itself isn’t anything new. It’s long been used to treat various types of cancers, particularly in prostates, but also in the lungs, skin and eyes. It uses an internal source of radiation – miniscule radioactive seeds – to destroy cancer cells and shrink tumors. It often reduces the amount of time a person has to undergo radiation treatment. 

One type of brachytherapy has been available to breast cancer patients for a while, but it involves a week’s worth of treatments twice a day, for 30 minutes at a time. The new procedure, available to patients who meet a certain criteria, only needs to be done once, during one appointment.

The shortened procedure has been done in Canada and England since 2004, according to Dr. Bradley Prestidge, the regional medical director for radiation oncology at the Bon Secours Cancer Institute. More than 10 years of data shows that it’s “just as good as any other treatments we offer,” he says.

Breast cancer is the second-leading cause of cancer deaths in women. In the U.S. alone, an estimated 253,000 new cases of invasive breast cancer will be diagnosed this year, with 41,000 deaths. 

Caught early, there are many treatment options.  A common one is breast-conserving surgery, known as a lumpectomy, followed by radiation treatment to destroy any potential remaining cancerous cells. The combination of surgery and radiation has been proven to increase survival rates in women with early-stage breast cancer. 

Radiation delivered by an external beam is a common option that treats the whole breast. Brachytherapy, meanwhile, treats just the surgical site and surrounding tissue. A big advantage is that other structures, such as the lung or heart, are not exposed to radiation. 

To be eligible for the breast microseed radiation treatment, patients must be at least 50 years old and have early-stage breast cancer with a tumor under 3 cm and no nodule involvement, Prestidge says.

Following tumor removal, titanium seeds filled with radioactive palladium are placed around the tumor cavity using a series of tiny hollow needles – about the size used to draw blood.

The seeds are deposited and left in place around the edges of the cavity, where the risk of cancer spreading is highest.

The seeds deliver a low dose of radiation over the next 60 to 90 days, eventually decaying and leaving only a harmless titanium casing behind, Prestidge says.

Prestidge says the results from the low-dose therapy are “as good or better as any other radiation.” There is more art to placing microseeds in the breast vs. the prostate, he says, which may be why the procedure hasn’t been more widely used. But Prestidge expects that with more awareness, the procedure will grow in popularity and be used more often.

“Because the treatment is delivered within the breast tissue, we use less radiation,” Prestidge says. “As a result, patients experience significantly reduced side effects. This one-time treatment option also helps patients receive more convenient cancer care so they can move along with their lives.”

The first Hampton Roads patient received the treatment at DePaul on Oct. 5th. Fran Crank said the procedure appealed to her because it was a one-hour, one-time procedure.

Crank, who is 82, was diagnosed with breast cancer after it was discovered during her annual mammogram. Her tumor was removed in August with a lumpectomy. The lymph nodes were clear, but because the type of cancer was aggressive, following up with radiation was suggested. She was offered the new brachytherapy procedure.

“When I was talking to some friends, they said I’d be a guinea pig, but I wasn’t,” Crank says. “It’s been done in Europe and elsewhere. It wasn’t the first time. It had been used and it was successful.”

The procedure itself went fine, with a team of doctors that included Prestidge and Dr. Juanita Crook, a British Columbia oncologist and renowned expert in the field of brachytherapy. Doctors used 19 needles to implant 115 microseeds where Crank’s tumor once was. 

For the first 90 days after the procedure, patients have to take some precautions, such as not being around pregnant women or small children. Prestidge suggests that women wear a thin lead shield in their bra for about two weeks to avoid exposure to others. 

“I’m in a good place right now,” Crank says. “I was pleased I was a candidate, and I was well-attended by excellent radiologists and doctors. It’s much easier have this one-hour, one-time procedure than to go back and forth for weeks.”