Studies have shown that giving radiation therapy to the breast after a lumpectomy helps keep cancer from recurring. Partial breast irradiation (PBI) delivers radiation directly to the site where the tumor was removed, targeting the area where the cancer would most likely recur and sparing healthy tissue. PBI is given two times a day for five days. Whole breast irradiation (WBI), which has been the standard therapy after lumpectomy, usually requires six to seven weeks of daily treatments.
One of the methods for delivering partial breast radiation for early stage breast cancer is MammoSite. The University of Maryland Marlene and Stewart Greenebaum Cancer Center (UMGCC) was the area’s first cancer center to begin offering partial breast radiation using this technology back in 2003.
With MammoSite, doctors place a balloon catheter into the cavity of the breast where the tumor had been surgically removed. Radiation oncologists then deliver internal radiation into the balloon twice a day for five days. When therapy is completed, the balloon is deflated and the catheter easily removed.
“MammoSite is minimally invasive, has been shown to be safe and can be performed as an outpatient procedure,” says William F. Regine, M.D., professor and chairman of the Department of Radiation Oncology at the University of Maryland School of Medicine. “It can significantly reduce the number of daily radiation treatments and their impact on healthy areas of the body.”
Targeted Internal Radiation Therapy Benefits Breast Cancer Patient
MammoSite patient cites the caring attitude of GCC physicians and staff with helping her through a difficult time.
It was just after going in for her annual physical exam that Terhea Washington finally decided to get her first mammogram.
Her doctor had urged her to get the mammogram five years ago, because Washington had cancer 20 years ago. "My primary care doctor had been on my case about getting a mammogram," said Washington. "So finally this time, I decided to get it. This year I got the courage. I could no longer put it off."
It was Washington's first mammogram. But when she had the test, the doctors found something they didn't understand. Washington went in for more views and they still couldn't figure it out. Then she had a biopsy. That's how she found out she had breast cancer. The doctors thought it was a stage I cancer, so it had been caught early. But they weren't sure if it had spread. Washington had done self-breast exams but she never felt the tumor because the lump was too deep in her tissue and not close to the surface.
Her doctor recommended three different medical facilities, including the University of Maryland Medical Center's Greenebaum Cancer Center (GCC).
Washington then called all three facilities and got very different responses. "When I called the first hospital it was very hard to get a live person," she said. I got voice mail. I was very put off by that." Next, she called another facility that her primary care doctor recommended, but the doctor she was referred to was not there anymore.
Then, she said, "I called the University of Maryland, and I got a live person right way," said Washington. "It was so good to be talking to a live person. It was comforting. I felt cared for immediately."
She first spoke with Karen Uhlik, surgeon Dr. Barbara Bass's appointment scheduler. "She was patient, understood my anxiety and talked to me nicely and made me feel very comfortable," Washington said. Although Dr. Bass couldn't take new patients at the time, Uhlik did her best to accommodate Washington. "Karen understood that I wanted a female doctor, so she checked to see if it was okay to add me to Dr. Bass's patient list. Dr. Bass agreed to see me," said Washington.
After that, GCC breast program coordinator Rose Muffoletto called Washington back the same day to see if she had any questions, or needed more information. Washington appreciated the attention. "They were just the best, so supportive," she said. "When I called my primary care doctor and told her I was going to receive treatment at the Greenebaum Cancer Center, she said the University of Maryland Medical Center was great."
Washington was then examined by Dr. Bass, who determined that the tumor was a stage I cancer. They scheduled a lumpectomy.
But the day before surgery, Washington had to go over to the Division of Nuclear Medicine to have a sentinel node injection. Dye was injected into her breast so that the nodes most at risk -- nodes most likely to pick up cancer and metastasize -- could be identified before the surgery was done.
After this, she met with radiation oncologist Edward Kiggundu, M.D. He told Washington about MammoSite, a new technology he recommended.
MammoSite is a targeted internal radiation therapy for patients with early-stage breast cancer who have had lumpectomies. It delivers high-dose radiation directly to the site where the tumor was removed, targeting the area where the cancer would most likely recur and sparing nearby healthy tissue.
MammoSite, used in conjunction with conventional "external beam" radiation, cuts two weeks off the length of daily radiation treatment following surgery. Patients can receive a higher dose because the radiation is concentrated in one area.
In Washington's case, Dr. Kiggundu told her that she'd have 10 less external radiation treatments than she normally would -- cutting down the amount of treatment time from six to four weeks.
As Dr. Kiggundu explained: "We decrease the length of treatment time but don't compromise the treatment dose. So we get the whole boost [MammoSite] in two treatments, which normally would have translated to two weeks of external beam radiation treatments."
He said the other advantage is that "the dose is delivered to exactly where we want it to go; it reaches the target. The target is the tumor bed (where the lump used to be). When you take out the lump there's always a chance microscopic disease did not get removed."
Dr. Kiggundu says other benefits include a reduction in skin side effects, which normally happens with external beam radiation.
"This is an innovative way of not only giving convenience to the patient as far as shortening the treatment time, but also reducing skin side effects," he said.
With external beam radiation, there is more redness, darkening, and peeling of the skin, as well as skin breakdown and long-term skin hardening. By doing MammoSite, we reduce the skin side effects because we're reducing the amount of external radiation treatments."
Most importantly, Dr. Kiggundu said "It's the best way of delivering prescribed radiation dose to the tumor bed (area where tumor was removed) without treating non-targeted tissue."
Washington had her surgery on Sept. 10, 2003. After she had the lumpectomy and lymph node removal surgery, Dr. Kiggundu inserted the MammoSite catheter.
Overall, Washington said, "I thought the surgery went very well. There was some discomfort [with MammoSite], but it wasn't uncomfortable enough that I would not do it again." After the surgery her doctor tested the lump and the lymph nodes. The news was good: they had removed all of the cancer, and it had not spread to her lymph nodes.
After the surgery Washington returned home and recovered for about a week. Then she went in to have her MammoSite treatments. She had two treatments, healed for a week and then a week after she began four weeks of external radiation treatments. She finished her last treatment on Monday, Nov. 10, 2003.
Washington has her own marketing and celebrity talent management agency. She plans to go back to work just after the new year .
She says her experience at GCC was a positive one, largely due to the caring attitude of her doctors.
"Dr. Kiggundu and Dr. Bass are both very competent, very patient doctors who spent a lot of time making sure my questions were answered," said Washington. "I could tell my care was very important to them."
And even when Washington felt reluctant about getting treatments, her doctors lent their support. "Dr. Kiggundu was very encouraging," she said. "He helped push me along, with that extra bit of compassion. He was very patient and, very concerned. So I felt confident that I was in capable hands."
For more information, contact the Department of Radiation Oncology at 410-328-6080.