Published: October 10, 2008 11:36 am            

MammoSite: Letting doctors treat cancer with technology

PRINCETON — Rebecca Broyles had no idea cancer was growing inside her when she scheduled her annual mammogram last January.

As had become her practice, the Princeton woman went for a physical, which included the cancer screening, and headed home without giving it much thought. A weekend trip pulled her away from home for a few days afterward, and the first signs of trouble arrived in the mail while she was gone.

“We got home and checked the mail, and I saw a letter from the radiology department,” Rebecca recalled this week. “When you see that, you're prepared, or at least I was, for bad news.”

The letter announced that the mammogram results were irregular and slated a follow-up appointment with an oncologist. When that appointment also pointed toward the possibility of very early signs of cancer, Rebecca made an appointment with a surgeon.

On Feb. 12, she underwent a biopsy of the lump, on the advice of Dr. David Mullins, and when those results returned, the fight became official; it was cancer.

With that news, Rebecca began to carefully climb what she called the “decision tree.”

“As soon as you hear the word cancer, all of a sudden, you have a tremendous number of decisions that are going to affect the rest of your life,” she said. “And, when you make one decision, it branches off into a whole series of other decisions and concerns.”

Although her cancer was discovered extremely early into the malignant growth cycle, Rebecca said she didn't want to spend a lot of time agonizing about endless decisions.

She asked Mullins exactly what her options were, and she said he outlined every avenue possible, from a radical mastectomy to a lumpectomy combined with radiation and/or chemotherapy, to a relatively new form of treatment known as MammoSite.

Since Rebecca's tumor was so small, doctors didn't believe she needed a mastectomy. A lumpectomy would remove the tiny cancer, but she would need follow-up treatment to ensure that the cancerous cells wouldn't recur at the same site.

Traditionally, patients who undergo lumpectomies face weeks of radiation and/or chemotherapy to kill any remaining cancer cells, but the newer radiation therapy delivers targeted radiation directly to the site of the cancer and cuts the length of time patients undergo radiation.

After reading all the literature Mullins provided and spending several days “internetting” to find all the information possible, Rebecca decided on the newer technology and shorter therapy cycle.

Although five days of localized radiation versus seven weeks of whole-breast radiation appealed to Rebecca, she didn't want convenience to sway her decision. After weighing all the options, however, she still believed the targeted treatment was best for her.

“I thought the physics of it were sound,” she said.

Mullins removed the tumor on Feb. 26 and inserted what's known as a spacer balloon to mark the site of the lumpectomy and identify exactly where the radiation unit should be placed. After a series of post-surgery testing, Rebecca still proved to be a good candidate for MammoSite treatment, so Mullins removed the spacer balloon and inserted another balloon, one that contained the radiation technology inside.

On March 3, Rebecca began the treatment at the Center for Cancer Care in Princeton. For one work week, five days, she went for radiation treatments twice daily, and although the idea of radiation was frightening, she said the experience was actually rather pleasant when combined with the expertise and competent caregivers she found locally.

“I went into a room and lay down in a slightly darkened room for maybe 10 minutes, and then, I'd leave,” she said. “The actual radiation didn't take 10 minutes, but there was some preparation that had to be done each time.”

After her five days of radiation, Rebecca's radiation balloon was removed, and her treatment shifted from aggressively targeting the cancer to keeping a close eye to make sure it doesn't return. As of this week, she said she's considered stable, and she only has to visit an oncologist for follow-up visits every three months, along with other doctors’ visits.

“I never gave it much thought before, but when I heard that, I thought, 'What a wonderful word — stable,'” Rebecca said.

•••

Dr. Eric Hopkins, Mullins' partner at Appalachian Surgical Associates, explained partial-breast radiation as a way to “reduce the length of time patients have to have radiation therapy, improve the quality of life and reduce the risk of recurrence.”

While conventional thinking and more established radiation techniques targeted the entire breast with radiation, MammoSite and other forms of partial-breast radiation pinpoint the area where the cancer grew originally. Since roughly 77 percent of breast cancer recurrences take place at the site of the lumpectomy, Hopkins said it makes sense to deliver concentrated doses of localized radiation over a shorter period of time.

Patients who are typically well-suited for partial-breast radiation are 45 years of age or older who have a tumor less than or equal to 3 centimeter in size. In addition, Hopkins said the area around the tumor site and lymph nodes must test negative for cancer cells.

While traditional radiation requires daily trips to a doctor's office over a series of weeks or months and often has side effects, such as burning of the skin, damage to healthy tissue surrounding the cancer site and fatigue, Hopkins said the side effects are less severe with partial-breast radiation.

First, it's much easier for patients to make the trip for treatment for five days than for seven weeks. And, since the radiation is so closely targeted to the tumor, there's less chance that surrounding tissue and skin will be damaged.

Because the radiation utilizes a balloon, Hopkins said, “You have a catheter hanging out of your skin for about a week. There's a small risk of infection with that.”

MammoSite and other forms of partial-breast radiation are relatively new. MammoSite was just approved by the United States Food and Drug Administration in 2002. For that reason, Hopkins said the long-term statistics on cancer survival and recurrence aren't available. But, the five-year numbers look promising.



In fact, according to MammoSite, women involved in a five-year study of the treatment experienced zero recurrence. More than 83 percent reported good to excellent cosmetic outcomes, and 100 percent would recommend the treatment to a friend or family member diagnosed with breast cancer.

Rebecca echoed those ideas.

“I would make the same decision again. I can't know the outcome for years, and I wouldn't know the outcome for years, no matter which treatment I chose,” she said. “Once you get the diagnosis, you always live with uncertainty.”

Even amid the uncertainty, Hopkins said he is confident the treatment is successful.

“Everything right now looks like it's just as good as whole breast radiation, or even better in some instances,” he said.

•••

While Rebecca was pleased to benefit from the technological advances of MammoSite, she said a strong support network was essential to her healing.

“Having people you can count on makes all the difference,” she said, rating her friends, family, husband and doctors among the best in the world.

She said everyone she encountered, from Princeton Community Hospital, Mullins and his associates, to the Center for Cancer Care proved extremely knowledgeable and compassionate.

“I'm glad to have the option of MammoSite radiation. The doctors I encountered were very forward-thinking and informed about current care trends,” she said. “It was very exciting to have access to that treatment here, at home … I trusted every doctor I had and thought their advice was very sound.”

And, she encouraged all women to schedule routine cancer screenings. Finding her cancer earlier armed her with more time and choices than a later diagnosis would have.

“I'm living proof that mammograms really do save lives,” she said.

Since October is Breast Cancer Awareness Month, Princeton Community Hospital is offering breast and cervical cancer screening for free on Saturday, Oct. 18, 8 a.m.-noon, in the Day Surgery Department. For more information or to register, call (304) 487-7283 or (304) 487-7074.

— Contact Tammie Toler at ttoler@ptonline.net.

        

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