By Beatriz E. Amendola MD FACR

It’s hard to believe, but breast cancer remains the single most common type of cancer in women. One of the most effective ways to treat the disease in its early stages is radiation therapy, which has been used since 1929 in the treatment of breast cancer.

Radiation therapy works by killing cancer cells within the breast, so that the patient can keep her breast. Conventional radiation therapy or external beam radiation (EBRT) is routinely used in early breast cancer after resection of the tumor. EBRT is usually given Monday through Friday, over a course of five to seven weeks, and radiation is usually applied to the entire breast and/or lymph glands. The treatments are given with external beam radiation (EBRT) using linear accelerators (high-energy radiation). EBRT is safe, painless and well tolerated, and is also used in locally advanced breast cancer combined with chemotherapy, so that the breast can be preserved. It can also be used after a mastectomy to prevent tumor regrowth in the chest wall; for a pre-cancerous disease, such as Ductal Carcinoma in situ and to treat advanced and metastatic disease.

Brachytherapy is a new twist on the old Radiation technique, which is garnering lots of attention. The treatment is done on an outpatient basis in one week (usually twice a day in the morning and late afternoon), and uses high dose remote control radiation that is transmitted into plastic catheters surgically placed in the breast. The term ‘brachy’ is Greek for short distance, and the benefit is that the radiation can be contained and delivered with a great deal of precision, limiting the radiation exposure to the health care professional. By using Brachytherapy, the radiation only enters the area of treatment (the breast) through the catheters for a few minutes each treatment, thus keeping unwanted radiation away from normal healthy tissues such as the heart and/or the lungs.

For certain patients this technique is superior to other forms of Radiation. Brachytherapy has been used in patients in many centers in the USAand Europe with excellent results. Because the treatment time is so short, it is especially suited for elderly patients, patients who live away from the center of radiation therapy and/or patients who live in locations where radiation is not an available option and they would need to travel to get the treatment.

One disadvantage to the treatment is that it requires minor surgery to place the plastic catheters into the breast tissue, and patients may not want yet another invasive procedure. Brachytherapy is especially useful for patients with advanced breast tumors, who need chemotherapy since the cancer drugs can be started after the surgical procedure, while patients using conventional EBRT can not start the treatment until the radiation is completed.

Before deciding to have Brachytherapy, keep in that not all patients are the same, nor do all tumors behave in the same way. Make your decision by using all resources available to you, including evaluation by a team of doctors, comprised of a breast surgeon, diagnostic radiologist, pathologist, medical oncologist and radiation oncologist.

Once everyone agrees, you can be comfortable that you’re quickly placing radiation right where you want it – in your breast – rather than in your entire body. Now that’s a high tech treatment worth talking about.

Beatriz E. Amendola MD FACR is a radiation oncologist based in Miami, FL, and the Director of the Brachytherapy Institute of South Florida. She is also a Diplomate of the American Board of Radiology and former Associate Professor and Director of Residency Training at the University of Miami, Department of Radiation Oncology.