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Monday, March 18, 2024
March 18, 2024

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Radiation targets breast cancer from within

PeaceHealth Southwest radiation oncologists are using a new technique, breast brachytherapy, to administer radiation.

By , Columbian Health Reporter
Published:
9 Photos
Drs. Faisal Siddiqui, left, and Michael Myers discuss a radiation dose plan for a patient while standing near the machine that delivers radiation to patients undergoing breast brachytherapy. Breast brachytherapy delivers radiation through a device placed in the cavity left in a woman's breast after a lumpectomy.
Drs. Faisal Siddiqui, left, and Michael Myers discuss a radiation dose plan for a patient while standing near the machine that delivers radiation to patients undergoing breast brachytherapy. Breast brachytherapy delivers radiation through a device placed in the cavity left in a woman's breast after a lumpectomy. (Amanda Cowan/The Columbian) Photo Gallery

Adriana Dorsey never imagined her routine mammogram would lead to a cancer diagnosis.

After her annual screening in August 2014, Dorsey got a call about questionable results. That wasn’t unusual; she’s been called back about what turned out to be harmless lumps before. She underwent more intense screening in early October and then left for a planned vacation to celebrate her 63rd birthday.

The day after her birthday, Dorsey learned she had breast cancer. The tumor in Dorsey’s right breast was small and the cancer hadn’t spread. She opted for a lumpectomy followed by radiation therapy.

Her surgeon, Dr. Jeffrey Sunshine, told Dorsey about a method of radiation, called breast brachytherapy, that’s an option for some breast cancer patients. The treatment would take only five days, as opposed to five or six weeks.

With the holidays approaching, Dorsey was ready to move on.

“I wanted to be myself as much as possible by Christmas,” said Dorsey, of Vancouver. “I wanted to get that behind me. I wanted to be healthy.”

 

The Strut Adjusted Volume Implant applicator delivers a form of accelerated partial breast radiation, known as breast brachytherapy, that uses catheters to deliver radiation from within the breast directly to the tissue surrounding a tumor cavity.

  1. Customized treatment: The radiation oncologist uses CT scans to create a customized treatment plan that will deliver radiation to the tissue surrounding the tumor cavity, while sparing the skin, chest wall, heart and lungs.
  2. Placement: The SAVI applicator, which is a bundle of catheters, is inserted through a small incision in the closed position. A dial is used to expand the catheters to fill the space in the breast.
  3. Radiation delivery: During treatment, the catheters are attached to a machine that delivers the radiation source, which is a small pellet. The radiation source works its way up and down each tube, pausing at specific intervals. Treatment is delivered twice a day for five days.

By mid-November, just a month after her cancer diagnosis, Dorsey had completed radiation treatment. She enjoyed the holidays with her family and by the start of the new year, Dorsey’s fatigue had subsided and her energy levels had returned to normal.

“A little bit of fatigue was worth putting up with for such a short period of radiation,” Dorsey said.

“I feel so blessed I had this option,” she added.

An option for some

Breast brachytherapy, or accelerated partial breast radiation, uses catheters to deliver radiation from within the breast directly to the tissue surrounding a tumor cavity. More traditional external radiation treats the whole breast from the outside.

Breast brachytherapy offers a couple of advantages. First, it spares healthy tissue from unnecessary radiation, said Dr. Michael Myers, a radiation oncologist at PeaceHealth Southwest Medical Center who offers breast brachytherapy.

“We want all of the tissue at risk to receive a targeted dose of radiation, while sparing two structures — the skin and the chest wall,” Myers said.

Brachytherapy also reduces treatment time from several weeks to five days, has fewer side affects and has great outcomes, Myers said.

Breast cancer patients have three radiation treatment options: one-week breast brachytherapy, 16-day treatment or 16-week treatment, he said.

“The one-week treatment option, the patients who get it, love it,” Myers said. “The downside is there’s an invasive procedure involved.”

Brachytherapy isn’t an option for everyone, however. Myers follows the most stringent of three eligibility guidelines for breast brachytherapy. Those requirements include patients who are 60 or older, have Stage 1 and estrogen-receptor-positive cancer, tumors that are not bigger than 2 centimeters and negative margins (the tissue surrounding the tumor). Myers says he also considers patients who fall outside of one of those areas — except the estrogen-receptor positive cancer — as candidates for the treatment.

How it works

PeaceHealth Southwest uses a single-site applicator called the SAVI applicator to administer brachytherapy.

After a patient undergoes a lumpectomy and the tissue surrounding the tumor is found to be clear of cancer cells, she then goes to Myers.

Myers uses an ultrasound to evaluate the tumor cavity and determines its size. The SAVI device comes in four different sizes — the smallest has seven catheters, the largest has 11. Those sizes tend to fit about 90 percent of patients, Myers said. If the cavity is too large, Myers delays placing the device to allow the cavity to shrink, as it does naturally over time.

When it’s time to place the applicator, Myers creates an incision in the side of the breast and slides the applicator, which is a bundle of small catheters (or tubes), into place. Once the applicator reaches the cavity Myers turns a small dial to expand the catheters to fill the space within the breast.

Once expanded, the applicator resembles a cooking whisk, with the expanded end inside the tumor cavity and the tails of the soft tubes extending outside the breast. The ends of the tubes are covered with a bandage.

After the applicator is placed, Myers works with the physicist to develop a personalized treatment plan.

During treatment, each of the catheters is attached to a machine called an after-loader, which delivers the radiation source. The radiation source — resembling a small pellet — works its way down one tube, pausing at specific intervals until it reaches the end and, finally, returns to the machine. The process repeats itself until the radiation source travels through each tube.

Each appointment takes about 30 minutes, with the radiation administration taking only five to 10 minutes. The patient undergoes radiation treatment twice a day — once in the morning and again about six hours later — for five days.

After the final treatment, Myers removes the device and uses liquid stitch to seal the incision spot.

Breast brachytherapy has existed in some form for more than 15 years. In the earlier years, though, the procedure was more “gruesome,” Myers said. It required multiple catheters placed in separate incisions along the side of the breast, and patients were typically put under anesthesia when the catheters were placed, he said.

“We’ve come a long way,” Myers said.

Other versions of single-site applicators came out in the years that followed. Myers first began using the applicators about nine years ago. He began using the SAVI device about five years ago, 2 1/2 of which have been at PeaceHealth Southwest Medical Center. A former PeaceHealth provider offered brachytherapy, as well, before leaving the organization, Myers said.

‘It all went so well’

Like Dorsey, Sandra Sechrist of Washougal first learned about brachytherapy from her surgeon. Sechrist had a consultation with Myers and decided brachytherapy was the best option.

“I just wanted to get it over with,” she said.

For both women, the weeklong treatment went smoothly.

Dorsey’s husband, Dan, drove her to her morning radiation appointments, then took her back for the evening doses.

She spent the first weekend trying to figure out how to sleep with the device’s “tentacles” sticking out.

“It was weird, but it didn’t hurt,” she said.

Sechrist agreed.

“The worst thing was having the device in my breast,” she said.

The device, she said, was mostly just uncomfortable, not painful. But if somebody bumped into Sechrist or she accidentally rolled onto that side of her body while sleeping, she would experience some pain.

Still, Sechrist said the minor discomfort was worth it.

“It all went so well,” Sechrist said. “I was really happy I made that choice.”

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Columbian Health Reporter