Definition & Overview
The placement of a radiotherapy afterloading expandable catheter following a partial mastectomy is an essential part of radiotherapy treatment for breast cancer. Patients who are diagnosed with breast cancer often undergo a mastectomy to have the cancerous breast tissue removed. They are then advised to undergo further treatment, such as radiotherapy or chemotherapy.
Radiotherapy for breast cancer works by killing any remaining cancer cells after the main tumour has been removed. It helps prevent more tumours from growing back. The advantage of radiotherapy is that it is more targeted. It can kill cells only in a particular area, which is called the field of radiation. This helps reduce the risk of destroying healthy cells.
Who Should Undergo and Expected Results
The placement of a radiotherapy afterloading expandable catheter is for patients who underwent a partial mastectomy for the treatment of breast cancer and have opted to undergo radiation therapy afterwards.
Although a mastectomy can remove the main tumour, there is still a chance that some cancer cells are left in the breast. These cancer cells may cause a new tumour to grow in the future. Radiation therapy can destroy these residual cancer cells to prevent tumour regrowth.
However, not all breast cancer patients need radiation therapy after a mastectomy. In fact, the treatment is only used in women who have a particularly high risk of having residual tumour cells. This risk is determined based on:
- The patient’s age
- Tumour size
- Tumour grade and microscopic appearance
- Surgical margin
- Number of axillary lymph nodes that had cancer cells
- Invasion of lymphovascular spaces within the tumour
The placement of a radiotherapy afterloading expandable catheter is one way to deliver radiation into the affected breast tissue. The procedure is called brachytherapy or internal radiation treatment. Instead of beaming radiation energy from outside the body, a catheter is used to directly deliver radiation into the specific treatment area. Since the delivery of radiation is targeted, doctors are able to deliver higher doses without causing more side effects to the patient. This treatment can be performed in conjunction with external beam radiation therapy.
In summary, the advantages of the placement of a radiotherapy afterloading expandable catheter are as follows:
- Fewer side effects
- Higher radiation doses
- Targeted delivery
- Fewer visits to the doctor
How is the Procedure Performed?
The following steps are taken to place a radiotherapy afterloading expandable catheter in the breast following a partial mastectomy:
- Once the tumour has been removed through a partial mastectomy, the surgeon will place a small soft balloon attached to a thin catheter just inside the mastectomy cavity. A small part of the catheter remains just outside the breast through a small incision.
- The catheter is placed at the side of the breast, allowing patients to go about their normal activities in between their treatment sessions.
- The balloon is then inflated with a saline solution so it will fit the cavity well.
- The catheter is secured in place with a gauze pad. This helps keep it from moving during the entire course of treatment.
- The radiation oncologist will take pictures of the catheter in the breast.
- After determining the correct radiation dosage, the catheter outside the breast is connected to an HDR (High-Dose Rate) machine. This machine inserts a radiation seed into the catheter. The seed will then travel all the way through the catheter and into the breast tissue to deliver radiation therapy to the target site.
- On the last day of treatment, the radiation seed is removed. The balloon is then deflated and gently removed through a small incision in the breast. The catheter will then be completely removed.
No radiation remains inside the breast once the afterloading expandable catheter is removed.
Most women report to feeling only minor discomfort or pain during both the insertion and removal procedures. It is normal, however, to see some drainage from the site where the catheter was inserted. This should go away after some time.
Possible Risks and Complications
Patients who undergo placement of a radiotherapy afterloading expandable catheter following a partial mastectomy are at risk of:
- Breakdown of fat tissue in the breast
- Mild breast pain
These are common side effects following any kind of breast surgery and can be expected to go away after some time.
Radiotherapy itself carries some risks. These include both short- and long-term reactions, such as:
- Skin damage, ranging from a light sunburn to a significant darkening of the breast skin
- Burning sensation
- Peeling of the skin
- Changes in breast skin texture
- Lymphedema or swelling of the arm or underarm
- Bracial plexopathy or injury to the nerves of the arms
- Numbness of the arms
- Tingling or weakness of the arms
Jagsi R. “Progress and controversies: Radiation therapy for invasive breast cancer.” CA: A Cancer Journal for Clinicians. 2013 December 2. http://onlinelibrary.wiley.com/doi/10.3322/caac.21209/full
Sadeghi M, Enferadi M, Shirazi A. “External and internal radiation therapy: Past and future directions.” Journal of Cancer Research and Therapeutics. 2010;6(3): 239-248. http://www.cancerjournal.net/article.asp?issn=0973-1482;year=2010;volume=6;issue=3;spage=239;epage=248;aulast=Sadeghi