Treatment isolates small area in breast

Partial breast irradiation is a new treatment being offered at Albany Medical Center. It involves us

Nancy Sullivan, now 64, was terrified when she was diagnosed with breast cancer on July 1, 2004.

“One of the biggest fears of my life was breast cancer,” said Sullivan, who lives in Hudson. “To me, it seemed like the most threatening thing that could happen to a person. I was very distraught.”

After having a lumpectomy at Albany Medical Center, she learned that because her tumor was so small she was eligible to have a new treatment being offered at Albany Med — partial breast irradiation, which involves using fiducial or soft tissue markers in the breast for accurate daily treatment.

“We use three tiny, 24 karat gold soft tissue markers that are implanted right around the area where the tumor was taken out,” explained Dr. Susan Gibbons, chairwoman of the department of radiation and oncology at Albany Medical Center.

The technique, offered in the Capital Region only at Albany Med, gives doctors a way to pinpoint radiation treatment.

“Patients with small, low-grade breast cancers can often do just as well with irradiation of just a portion of their breast rather than necessarily treating the whole breast,” said Gibbons.

Accurate and fast

The markers ensure that the portion being treated each day is exactly right.

Partial breast irridation (PBI) has been offered at Albany Medical Center for about four years. The main advantage for patients is the ability to maximize the dose of radiation to the part of the breast that’s at highest risk for having cancer cells still in it after surgery. The technique spares the rest of the breast, as well as other nearby normal tissue such as the lung and heart from unnecessary exposure.

“And because we are treating a smaller volume, we can do it more quickly,” said Gibbons.

So instead of taking six to seven weeks to complete radiotherapy, doctors can do it in under three weeks.

Putting markers into the breast is an office procedure that takes about 15 minutes. Once in place, the markers act as a map inside the breast. Treatment planning is done by reconstructing where the tumor bed is in relation to those three markers.

By scanning the patient before treatment each day, the radiation therapists can then center the treatment beams on the markers, guided by a computer system that will deliver radiation to the exact site.

“The therapist can digitize the marker positions into the computer and adjust the machine as needed to center on them,” explained Gibbons. “Once that is done, treatment is started and delivered around that set point. So there is no guessing involved.”

The external beam treatment is delivered with a very focused beam called intensity modulated radiation therapy or IMRT, Gibbons continued.

“Because the beam is so focused, it becomes very important that every day we know exactly where it’s aimed,” she said.

That’s where the soft tissue markers come into play. Using the gold markers is a simple and accurate way to aim the beam precisely without exposing patients to the unnecessary radiation of CT scans, for example.

More normal lifestyle

The best candidates for partial breast irradiation are women over the age of 40 with small, low-grade tumors and no lymph node involvement.

Gibbons has used the technique on approximately 80 women with excellent success.

“Women tolerate it very well, and they like it a lot,” said Gibbons. “During treatment, they have virtually no skin irritation and much less fatigue than we see with standard radiation.”

Because they have less fatigue, it’s easier for them to continue with their normal lifestyle during treatment.

Sullivan said she was amazed at how easy the process was.

“I expected it to be a long, drawn-out process, and it was not,” said Sullivan. “I had no pain from the radiation and almost no irritation to my skin. I also did not need to have chemotherapy, which was a plus.”

Today, Sullivan said she feels good except for joint pain and a headache because of a drug (aronasin) she takes to stop estrogen from producing in her body and reduce her risk of getting a second breast cancer.

“I tell myself if it’s just for five years, I can do this,” said Sullivan. “Overall, I’m happy to be alive.”

Likely to catch on

Gibbons, who recently presented her study findings at breast cancer symposia in San Francisco and San Antonio, said she’s not sure why more centers don’t use the fiducial marker technology.

“But judging from the enthusiastic responses we saw at the meetings, and the phone calls we’ve gotten, more and more centers will be offering it soon,” she predicted.

“Maybe because partial breast irradiation as a treatment option has only gained popularity over the last five years, and the soft tissue markers have only been around for about the same amount of time, most centers haven’t thought to use the markers for breast treatment,” she added. “It’s just a matter of putting them together.”

The technique with fiducial markers can also be used to treat prostate cancer and head and neck cancers, said Gibbons.

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