Download Expanding Breast Cancer Treatment Options for Women with Early

Expanding Breast Cancer Treatment Options for Women with Early Stage
Breast Cancer: Accelerated Partial Breast Irradiation
Rachel Richards, MS, APRN, Nurse Practitioner & Breast Health Navigator,
Comprehensive Breast Health Center, Lahey Clinic North Shore, 2011 Nursing Research Fellow
Background
For several decades, whole-breast irradiation (WBI) has been
used as the standard of care to reduce the risk of in-breast
recurrence following breast conserving surgery (lumpectomy) for
early stage breast cancer. Treatment is given utilizing external
beam radiation, 5 days/week, for up to 7 weeks. This treatment
schedule can be problematic for working women, elderly patients
and those who live a great distance from a treatment facility
(Yeo, Kim, Kwak, Kim, Park, Kim et al., 2010).
CT Scan of balloon catheter in breast
APBI vs. WBI:
Treatment field highlighted in red
Over the past several years, Accelerated Partial Breast
Irradiation (APBI) has gained interest as an alternative to
traditional WBI. APBI has several benefits, including decreased
overall treatment time (5 days) and a decrease in the radiation
delivered to healthy tissue and adjacent organs (Njeh, Saunders
& Langton, 2010).
Review of the Literature
To date, clinical trials have shown similar overall survival and
disease free survival with APBI versus WBI at up to 10 years of
follow-up. The research also reports good to excellent cosmetic
results with APBI. However, experts caution that more research
is needed as long-term safety and efficacy of APBI is unknown
(Smith, Arthur, Buchholz, Haffty, Hahn, Hardenbergh, et al.,
2009).
How is APBI performed?
It Takes a Team
There are several techniques that are used for APBI, including multi-catheter
brachytherapy, balloon catheter brachytherapy and localized external beam
delivery (Wadasadawala, Sarin, Budrukkar, Jalali, Munshi & Badwe, 2009).
Lahey utilizes both the localized external beam and more recently introduced
balloon catheter brachytherapy, which involves:
 Placing a small balloon catheter into the lumpectomy cavity.
 A radioactive source (seed) is positioned into the balloon through
access ports in the catheter for each treatment and then removed.
 Treatments are delivered twice a day (6 hours apart) for five days,
at which time the balloon is deflated and removed.
Who is a candidate for APBI?
Patients should be carefully selected for APBI and properly informed of the
benefits and risks of this type of radiation treatment. The following table
summarizes the consensus statements for eligibility from the American Society
of Breast Surgeons and the American Society for Radiation Oncology (ASTRO).
American Society of
Breast Surgeons
ASTRO
“Suitable”
ASTRO
“Cautionary”
Age
> 45y
> 60y
50-59y
Histology
IDC* or DCIS**
IDC*, Mucinous,
Tubular, Colloid
ILC***, pure
DCIS** < 3cm
Total Tumor Size
< 3cm
< 2cm
2.1-3.0cm
Surgical Margins
Negative microscopic
Negative by 2mm
Close (< 2mm)
Sentinel Lymph Node
Negative
Negative
Negative
*IDC: Invasive Ductal Carcinoma **DCIS: Ductal Carcinoma In Situ ***ILC: Invasive Lobular Carcinoma
Administration
Breast Imaging
Nursing
Breast Surgery
Radiation
Oncology
Breast Health
Navigator
Visiting Nurse
Association
Pathology
Ambulatory Surgery/
PACU
APBI at Lahey Clinic
Lahey’s dedication and commitment to offer patients the most
advanced options for diagnosis and treatment of breast cancer
is exemplified by the expansion of the APBI Program to include
the technique of balloon catheter brachytherapy.
Lahey’s first brachytherapy patient successfully
completed her treatment in February 2011.
In March 2011, four more women successfully completed
adjuvant radiation treatments with APBI.
Program evaluation is on-going. The program has utilized exit
interviews with patients to gain insight into patient perspectives
and experiences. Additionally, the team continues to meet to
discuss past experiences and determine ways to enhance the
program design, patient satisfaction and outcomes.