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Clinically Speaking: MammoSite: Making Life Easier for Many Breast Cancer Patients

 

More than 20 years of data confirms that breast conservation therapy provides an option equal in terms of overall survival to mastectomy (1). Nevertheless, some breast cancer patients and their physicians still choose mastectomy.

Why would a patient opt to undergo a potentially disfiguring mastectomy when breast conservation therapy has been proven equally effective? Most often, the decision is based on convenience.

Traditional radiation therapy takes place five days a week over a period of five to seven weeks. For patients who work, have family obligations, or who live considerable distances from the treatment facility, the obstacles presented by a lengthy treatment period are often enough to make them opt for mastectomy. Even more troubling, 15 to 30 percent of women undergoing lumpectomies elect not to undergo prescribed radiation (2,3) leaving them at significant risk of local recurrence.

The MammoSite Targeted Radiation Therapy system, which received FDA clearance in 2002, provides early stage breast cancer patients who are candidates for lumpectomy a way to complete their radiation therapy in just five days rather than the typical five to seven weeks.

With MammoSite, a balloon catheter is placed directly at the site of the lumpectomy. Following CT scans to confirm ideal placement and suitability of the course of treatment, a radiation pellet is inserted into the balloon catheter. Treatment then takes place two times per day for five days–in the morning for insertion of the radiation pellet and in the evening to remove the pellet. Following the five days of treatment, the balloon catheter is removed and treatment is complete.

Because MammoSite is targeted directly to the tumor site rather than the whole breast, there is less scatter radiation and thus a smaller risk of damage to healthy tissue and less painful burning and hardening of the skin that is often associated with whole breast radiation.

Currently, MammoSite is only an option for a certain subset of patients–those age 60 or older who have early-stage breast cancer–and we still lack long-term clinical outcome results. Nevertheless, preliminary evidence is encouraging, and I’m pleased with the results I’m seeing.

I’ve placed about 30 MammoSite catheters since 2006 and am using them more frequently now than ever. MammoSite requires a fair bit of coordination between the surgeon and radiation therapist, but it’s worth the effort. Almost all of my patients who have elected to have the procedure have been pleased with it. One hundred percent of patients in the initial clinical trial said they would recommend MammoSite therapy to a friend or family member, and all said that they would use the therapy again if they had to do it over.

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BIO:
Randal O. Graham, MD, FACS, joined Premier Surgical Associates in 1991. He is board certified in general surgery and vascular surgery by the American Board of Surgery and is a fellow of the American College of Surgeons.

References

1. Fisher B., Anderson S, Bryant J., et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002; 347(16):1233-1241.

2. Pruthi S, Boughey JC, Brandt KR, et al. A multidisciplinary approach to the management of breast cancer, part 2: therapeutic considerations. Mayo Clin Proc. 2007; Sep; 82(9):1131-1140.

3. Vicini FA, Baglan KL, Kestin LL, et al. Accelerated treatment of breast cancer. J Clin Oncol. 2001; Apr 1;19(7)1993-2001.

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