Breast Cancer Treatment Options

What have we learned about treating breast cancer?
Most breast cancer today is found quite early and is discovered by screening mammography and/or MRI. We have found that either a complete mastectomy, or a removal of a part of the breast followed by radiation produce equivalent results. The benefits of the later result from the patient being able to maintain her own breast without losing any of the benefits of total mastectomy. The significant survival benefits have arisen from better body wide treatments including hormonal and/or chemotherapy. We have found that there are several types of breast cancer, identified through study of the specimen removed at surgery, and tailoring treatment to the specific type of cancer is becoming the standard. New treatments such as targeted antibody therapy, pamidronate, more than 5 years of hormonal therapy and others all have contributed to improved survival, if used in a patient identified to benefit from the particular therapy used.

What are the options in terms of External Beam?
External beam radiation is the most commonly used therapy. The concept has always been that one must treat the entire remaining breast after partial breast removal. This is now being challenged, but external radiation is the standard of care. The difficulty with external beam radiation is that it takes over 6 weeks of daily radiation. The other problem is that is gives radiation to the underlying ribs, lung and in some cases a small amount of heart. Thus, we are using more and more IMRT to limit the dose to the underlying structures, although some claim that 3D therapy can do the same thing, and it is considered on a case by case analysis.

PARTIAL BREAST IRRADIATION: WHAT IS THE SKINNY ON PARTIAL BREAST IRRADIATION?
The newest approach is using Partial Breast Irradiation, rather than treating the whole breast. This can be done a couple of ways.

Catheter-based Partial Breast therapy
The first is to use a catheter placed in the cavity left after the cancer is removed. It is only suggested in a limited number of cases, treats only the cavity of the tumor, and may have more complications. It still takes 10 treatments in the radiation department, rather than 30, but is given twice a day over 5 days, and thus takes up the entire day during that period of time.

Accelerated Partial Breast Irradiation using External beam radiation
The other option is using external radiation directed at the breast cavity alone, and doing that in a shorter period of time. The advantages are that it is done more rapidly, but the breast tissue that is irradiated receives very high daily dose of radiation delivered to a smaller area. Another disadvantage is that the entire breast is not treated. Another potential disadvantage is that the cosmetic result may suffer over the life of the patient.

This is the position of treatment that the patient is in, with her arm over her head and lying flat on the table.	This shows the breast in red and chest wall in green. The lung is in blue and the heart is in red. Our goal is to treat the breast and spare the underlying heart and lung as well as avoiding hot spots of radiation over critical areas.	The use of a catheter inserted into the cavity of the breast cancer, after it is removed, is called partial breast irradiation. A catheter called the Mammosite and others, provide the entre to the inside of the breast for a radiation source to be placed. These treatments are give over 10 treatments in 5 days. The radiation treats only the cavity of the breast cancer and not the entire breast. The reason to treat the entire breast is that patients develop other breast cancers over their lifetime.