Saving...

What criteria do you follow in deciding to use high dose rate brachytherapy for breast cancer?

Cancel

Topics (Tags):

Brachytherapy Radiation Therapy High Dose Rate Brachytherapy Radiation Radiation Treatment High Dose Rate Radiation Breast Radiation Treatment

Topics:

Brachytherapy X Radiation Therapy X High Dose Rate Brachytherapy X Radiation X Radiation Treatment X High Dose Rate Radiation X Breast Radiation Treatment X

Done

Diseases:

Done

Answers (1)

MattKatzMD (Physician - Oncology - Radiation (Verified) ) - 08 / 18 / 2011

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.

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.

Cancel

Note: Usernames have been made anonymous and profile images are not shown to protect the privacy of our members.

Note: All content on this site is informational and not a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider with questions regarding your health.

Flag Content

Please expain why you are flagging this content. Thank you.

Cancel

Thank you for flagging this content. We will look into it right away.

Give a 'Thank you' to

Cancel

Add Answer

Question:

Optional: What context or background information is relevant to this request?

Notes:
The more clear and thorough your request, the more likely you will receive support.
Many of our members are learning from this information or english might not be their first language. Please use standard english and spell out all words. For example, use 'you' instead of 'u'.

Submit

Thank you for sharing your question.

We will notify other members of your question. Responses will be sent to your email account as well as viewable at the following link:

We are finding other members now to join the chat.

Click here to start the chat.

Cancer questions and answers.

Personalized, helpful, and accurate health answers.

Join Via Facebook

Join Via Twitter

Question Statistics

Latest Activity: 08 / 18 / 2011
Views: 283
Followed By: 2 members