Home E-Weekly November 13, 2006

In-office Breast Cancer Procedure Shows "Excellent" Cosmetic Results

Published: October 10, 2007

Ninety percent of patients undergoing the time-compressed Mammosite procedure for treatment of breast cancer experience good or excellent cosmetic results, according to a study presented by Medical University of South Carolina researchers at the American Society for Therapeutic Radiology and Oncology annual meeting last week. By comparison, about 75 percent of patients undergoing traditional whole-breast radiation see good or excellent results.

MUSC researchers documented the cosmetic results for their first 100 patients, starting when the procedure received FDA approval in 2002, at two-year follow-up exams. Only two factors contributed to fair or poor outcomes: infection during or after therapy and irritation associated with the balloon's being too close to the skin surface.

"Because we were one of the first to use Mammosite, we've been able to collect a lot of patients and very quickly been able to generate data with long-term follow-ups," says lead researcher Anthony E. Dragun, MD, the chief resident in radiation oncology at MUSC. "One of the initial concerns with the procedure was that taking non-invasive, external beam radiation and replacing it with [radiation and] an invasive procedure to implant the balloon catheter would adversely affect cosmetic results. Especially because there are higher doses of radiation over a shorter period of time."

Despite those concerns, 90 patients had good or excellent results.

"The largest study out there looked at 5,000 women; 80 percent had good to excellent outcomes," says Dr. Dragun. "We can't say [Mammosite] is definitively better, but at worst it's comparable, and it has the potential to be better if this data holds up, as physicians get more time and experience."

The keys to good outcomes are aggressive use of antibiotics and the ability to properly place the balloon. Surgeons place the MammoSite device in an in-office procedure under local anesthesia after the lumpectomy. Radiation oncologists then use the device to guide radiation only to that breast tissue over a five-day (as opposed to six-week) treatment time, sparing the remaining breast tissue from further radiation.

"At the beginning, we were underestimating the potential for infection with these patients, and three of the first 15 patients had poor results because of that," says Dr. Dragun. "Surgeons treated the catheter as they would any other drain. But when we started keeping patients on antibiotics the entire time the drain was in place and stressing meticulous care of the catheter site by patients and staff, we had just one poor outcome in the subsequent 85 patients."

Further, surgeons have to ensure there's enough space between the skin surface and the cavity created by the lumpectomy to avoid unnecessary radiation side effects, such as redness and peeling of the skin, he says. Ultrasound can be used to aid this part of the in-office procedure, or the surgeon can implant a spacer as part of the lumpectomy in anticipation of placing the balloon catheter later.

"Our results are very encouraging, and they shouldn't decline over time," says Dr. Dragun. "They best part is that patients don't have to trade convenience for cosmetic outcome."
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