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Methods of Delivery for APBR

Program: Partial Breast Irradiation for Early Stage Breast Cancer Patients
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Dr. Kim:

Sure. So absolutely there is three main ways at this time that APBI, or accelerated partial breast irradiation, can be delivered, and two out of the three ways we actually perform here at the SCCA. The one that we do the most or the technique that we use the most is the multicatheter interstitial breast brachytherapy approach, where we insert multiple catheters into the breast. They go through in through the breast. These catheters are hollow because later we place little radioactive sources into these catheters for a short amount of time, and they sit inside these catheters and release radiation, and basically it treats, as it releases radiation it kind of releases a cloud of radiation and it treats the area of high risk in the breast. And that's what we have. We have actually lots of experience here at the SCCA and UW with many patients on this treatment.

The other way, the other two ways, one is called MammoSite, and it's a procedure or a technique that we don't actually use here, but at other places in the Seattle area they do use this type.

And then the third approach is the 3 D conformal, which is similar to the external beam or the standard whole breast radiation in that it's not an invasive procedure. It's basically little mini beams that come in and target the tumor bed area from the outside. And that's a little bit newer of a technique, but we do do that as well on study.

Andrew Schorr:

All right. So let's go through this, and also explain what it means "on study" too. So the point is it's putting the radiation where you believe there is the greatest risk, whether you are firing it from the outside or whether it's being placed in the inside.

Dr. Kim:

Exactly.

Andrew Schorr:

And used just temporarily. And just so we can understand this sort of multicatheter approach, so these are like little tubes, right?

Dr. Kim:

Yes.

Andrew Schorr:

Little tiny, little tubes put in the area of where the tumor had been or the other areas that you are concerned about, right?

Dr. Kim:

Exactly.

Andrew Schorr:

And these radiation pellets go in there I guess. Are they pellets?

Dr. Kim:

Well, they are pellets, but they are actually temporary. They are placed into the catheters, and they sit for a few seconds, and then they are removed. We program the computer to have the radioactive source sit in each of these catheters for a certain amount of time, or they have specific dwell times.

Andrew Schorr:

Right. Right.

Dr. Kim:

In these catheters. So it's a little bit different than some of the other interstitial brachytherapy treatments let's say for, that we often hear about for, say, prostate cancer where the seeds are actually permanent, and they sit, they are in the prostate, you know, permanently. This approach is a temporary approach, and the doses are higher, so we call it high dose rate.

Andrew Schorr:

Right. And that's the idea is to put a high dose of radiation, cancer killing radiation, but right where it needs to be and not radiating areas of tissue that don't need it.

Dr. Kim:

Exactly.

Andrew Schorr:

Okay. And of course that has great benefit for patients. So if it's done, I believe the multicatheter approach is done over five days, or are both of these done over five days?

Dr. Kim:

All treatments, right now the accelerated partial breast irradiation treatments are all over a five day course, and it's done twice a day over five days so patients receive ten treatments overall, which is a great relief for a lot of patients who have busy schedules because six weeks of radiation just, you know, would be quite difficult to manage.

Andrew Schorr:

Right. And of course you at the SCCA have some patients who come from a distance, from Alaska or Montana or wherever, so this way they are here, and they have the surgery, lumpectomy, radiation, and then they are going home.

Dr. Kim:

Absolutely. And we have treated patients from Alaska and other, you know, out of state patients often because a lot of these places don't have a radiation facility nearby, and so the alternatives would be either no radiation which is, you know, not standard of care clearly from many studies that we have, or a mastectomy which would be just, you know, unfortunate. So you know, this is a great way of offering radiation treatments to patients who otherwise wouldn't be able to receive it.

Andrew Schorr:

Now, we said we would explain this term "on study." So you have been having clinical trials or studies, both here and others around the world trying to assess is this targeted radiation approach as good in terms of helping women avoid a recurrence of breast cancer. So what do we know now? Are the studies ongoing? And as I mentioned at the beginning, what's the opportunity for people to have this approach outside of a clinical trial?

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