Shorter breast cancer treatment with brachytherapy

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For Robin, it was an easy choice — five days of an accelerated treatment for breast cancer versus six weeks of traditional radiation therapy.

Developed in 1991 by Robert Kuske, MD, a radiation oncologist and independent member of the HonorHealth medical staff, brachytherapy uses catheters to deliver one or more radioactive seeds to the tumor bed. The treatment works from inside the breast as opposed to a radiation beam projected onto the breast from the outside.

Robert Kuske, MD

“This therapy works well for women with early-stage breast cancer,” Dr. Kuske said. “And, because the treatment takes place over days, not weeks, it fits with their busy lives.” Robin, 65, had a lumpectomy in her right breast in December 2018. As an early-stage breast cancer patient — stage 0, 1 or 2 — she was a good candidate for brachytherapy. She also met Dr. Kuske’s other eligibility standards:

  • Her tumor was three centimeters or smaller.
  • Her surgeon removed it with clear margins, which meant no cancer was found at the edges.
  • Her lymph nodes were negative for cancer.
  • She was older than 40. Women younger than 40 tend to have more aggressive cancer.
  • She could begin brachytherapy within six weeks of her surgery.

Breast implants were a factor

An Alaska native, Robin consulted with her doctor in Anchorage to determine what treatment would be best for her.

Because she had worked in a cancer treatment center, Robin knew the side effects of traditional (external beam) radiation that lasts five days a week for six to seven weeks: major fatigue after two weeks and burning of the skin. In addition, she had breast implants, and she knew that traditional radiation could cause them to harden, requiring their removal. Robin’s surgeon had read about brachytherapy and recommended Dr. Kuske. Dr. Kuske’s work in brachytherapy not only spares the heart and lungs from possible radiation exposure that can occur with traditional radiation therapy, it also can be a suitable treatment for women with implants.

A month after her surgery, Robin consulted with Dr. Kuske and began her therapy in mid-February 2019.

Partial breast radiation

Dr. Kuske said the inspiration for his work was a Venezuelan oil company CEO who came to him for breast cancer treatment.

“She told me she wasn’t going to lose her breast, and she didn’t have time for six weeks of treatment,” he said. “She was a pioneer.”

He knew that brachytherapy had been used successfully by gynecologists and for patients with prostate cancer and soft-tissue sarcoma.

“She forced us to think outside the box,” he said.

Robin’s brachytherapy treatment

By treating only the affected part of the breast with a radioactive seed, Dr. Kuske shortened her therapy to less than a week.

“It was a paradigm shift in the treatment of breast cancer,” he said.

The success of this idea led to the first research trial, then to subsequent national trials that Dr. Kuske directed. His research and practice of brachytherapy has been published in U.S. and international textbooks, trade association journals and other publications.

Robin’s brachytherapy treatment

Dr. Kuske used lidocaine to numb Robin’s breast before using a CT scan and needles to place 20 plastic catheters inside. Each thin tube would carry a sliver of radiation. Once they were placed, he hooked up each catheter to the radiation machine.

“I was awake and could talk with the doctor, but I couldn’t see what was happening because I was lying on the CT scan table,” Robin said. “I never felt any pain.” Each radiation treatment lasted about 12 minutes, and she felt only a small vibration. The catheters remained in Robin’s breast until the therapy was complete, a total of eight days from the time the catheters were inserted.

“The first two nights of sleeping were a little difficult for me because I couldn’t sleep on my right side,” Robin said. “The only other side effect I experienced was a little itching.”

After the therapy, Dr. Kuske told Robin not to lift anything heavier than 10 pounds for six weeks. That meant she couldn’t do one of her favorite yoga poses, downward-facing dog.

Today, Robin is cancer-free and back doing what she enjoys most — walking, hiking and practicing yoga, including downward-facing dog.

The HonorHealth Virginia G. Piper Cancer Care Network offers a variety of breast cancer treatments. Call 855-485-4673.