High Dose Rate Radiation

The use of radiation therapy has been a standard treatment option for women undergoing lumpectomy since publication of NSABP B-06, a clinical trial conducted about 30 years ago. At that time external beam radiation (also called teletherapy) was used to treat the whole breast. While there have been some tweaks, whole breast radiation therapy remains the current evidence-based gold standard.

There has been interest if focusing radiation more on the surgivcal area only, the lumpectomy cavity. This is called partial breast irradiation and is currently under study, though promising results suggest it a reasonable option. High-dose rate brachytherapy (brachy meaning close) is a way to deliver higher doses to a more focused area.

Criteria for using HDR brachytherapy on clinical trials NSABP B-39 are listed here: http://bit.ly/r8rED1 . Currently, off study there are patients who are considered suitable based upon consensus guidelines from 2009:

Patient Factors: Women 60+ years; no BRCA mutations.
Tumor Factors: 2 cm or less invasive ductal cancer; ER+; negative margins (2mm or more); no lymphovascular invasion; no involved nodes.

Here's a link to a screenshot from the article. http://i.imgur.com/2YxQt.jpg
There are also some technical considerations.

However, not everyone agrees. William Beaumont has tended to be more willing to consider HDR brachytherapy and PBI for some patients deemed unsuitable in the 2009 consensus paper (link = http://1.usa.gov/qPYTv0). It's a controversial area that's still evolving, and varies beyond just the criteria above for each patient. So worth a long discussion if you're thinking about lumpectomy for the pros/cons of whole breast vs partial breast radiation. The use of radiation therapy has been a standard treatment option for women undergoing lumpectomy since publication of NSABP B-06, a clinical trial conducted about 30 years ago. At that time external beam radiation (also called teletherapy) was used to treat the whole breast. While there have been some tweaks, whole breast radiation therapy remains the current evidence-based gold standard.

There has been interest if focusing radiation more on the surgivcal area only, the lumpectomy cavity. This is called partial breast irradiation and is currently under study, though promising results suggest it a reasonable option. High-dose rate brachytherapy (brachy meaning close) is a way to deliver higher doses to a more focused area.

Criteria for using HDR brachytherapy on clinical trials NSABP B-39 are listed here: http://bit.ly/r8rED1 . Currently, off study there are patients who are considered suitable based upon consensus guidelines from 2009:

Patient Factors: Women 60+ years; no BRCA mutations.
Tumor Factors: 2 cm or less invasive ductal cancer; ER+; negative margins (2mm or more); no lymphovascular invasion; no involved nodes.

Here's a link to a screenshot from the article. http://i.imgur.com/2YxQt.jpg
There are also some technical considerations.

However, not everyone agrees. William Beaumont has tended to be more willing to consider HDR brachytherapy and PBI for some patients deemed unsuitable in the 2009 consensus paper (link = http://1.usa.gov/qPYTv0). It's a controversial area that's still evolving, and varies beyond just the criteria above for each patient. So worth a long discussion if you're thinking about lumpectomy for the pros/cons of whole breast vs partial breast radiation.