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New Treatment Options for Breast Cancer

May 08, 2012

Washington Radiation Oncology Center Offers Innovative Therapies for Cancer Patients

This spring, the Washington Radiation Oncology Center is adding two new treatment options for certain cancer patients. High-dose rate (HDR) brachytherapy and prone breast radiation therapy not only can help improve the accuracy of treatment but also can help minimize injury to tissues surrounding the areas targeted for irradiation.

"Accelerated partial breast irradiation or (APBI) is a form of HDR brachytherapy, that involves quick bursts of high-dose radiation which greatly reduces treatment time," says Ranu Grewal-Bahl, M.D., radiation oncologist and Medical Director of the Washington Radiation Oncology Center. "Using APBI, we can shorten the treatment time to one week, compared to the five to six weeks usually required for standard external beam radiation therapy."

Advantages of HDR Brachytherapy

HDR brachytherapy can be used to treat a variety of cancers, including prostate, breast, cervical, uterine and skin cancers.

"We anticipate using HDR brachytherapy primarily for breast cancer," Dr. Bahl notes. "In the past, breast cancers were treated by performing mastectomies. Now it is more common to use breast-conserving therapy, with a lumpectomy followed by external beam radiation. Recently, there has been more interest in targeting radiation directly to the area where the lump was removed rather than irradiating the entire breast, and HDR brachytherapy does precisely that."

HDR brachytherapy can be performed with either a balloon-type catheter that inflates once it is inserted or with a bundle of catheters that resembles a whisk, which is inserted through a single entry point.

"The catheter can be put in place either during lumpectomy surgery or after surgery using the same scar and ultrasound guidance," Dr. Bahl says. "In either case, we also would perform a CT scan to verify the catheter is in the proper location. Then a computer-controlled remote device delivers a targeted dose of radiation to the breast tissue immediately surrounding the surface of the catheter balloon to kill any cancer cells remaining in the margins of the lumpectomy site. The patient receives a dose of radiation twice a day for five days, for a total of 10 doses. The catheter must remain in place until treatment is completed."

According to Dr. Bahl, lumpectomies followed by radiation are considered more effective than lumpectomy surgery alone. "Preliminary data over the past five years indicate that HDR brachytherapy has the same success rate as whole-breast radiation," she says. "HDR brachytherapy also produces good-to-excellent cosmetic results, with less skin irritation and minimal destruction of breast tissue."

HDR brachytherapy is not suitable for all breast cancer patients.

"This treatment is generally better suited to low-risk patients with tumors that are smaller than 3 centimeters and with no lymph node involvement," Dr. Bahl cautions. "Also, the patients are usually over age 50 and post-menopausal. The physicians on our Tumor Board will carefully screen all cases to make sure the patients are suitable candidates for this type of treatment."

Prone Breast Radiation Therapy

Patients who are better suited to whole-breast irradiation using external beam radiation therapy may be good candidates for receiving radiotherapy while in a prone (face down) position, instead of in a supine (flat on the back) position.

"With prone breast radiation therapy, the patient is positioned on her stomach on a specially designed table top that has a hole for the breast being treated," Dr. Bahl explains. "When the woman is face-down, the breast is below the table, and we can treat it with lateral radiation beams. Because the breast hangs away from the body, radiation exposure to surrounding tissues and organs is minimized."

Dr. Bahl notes that when patients are treated while on their backs, radiation applied to the breast on the right side often reaches the right lung, while radiation applied to the left breast may reach the heart and left lung. "With prone breast radiation therapy, 85 to 90 percent of patients will have no lung or heart tissue in the treatment field," she says. "Treatment in the prone position also causes far less skin damage. It is especially beneficial for patients with larger breasts who tend to get worse skin reactions when treated in the supine position."

The Washington Radiation Oncology Center is one of very few facilities in the Bay Area to offer prone breast radiation therapy. All treatments are supervised by Dr. Bahl or her colleague, radiation oncologist Michael Bastasch, M.D. The experienced staff at the Radiation Oncology Center also includes three licensed radiation therapists, a medical physicist, a licensed dosimetrist, and a licensed vocational nurse (LVN).

Washington Hospital Cancer Care Programs

The Washington Radiation Oncology Center is located at 39101 Civic Center Drive in Fremont. Visit www.whhs.com/cancer or call (510) 796-7212 for more information.

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