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Device May Customize Radiation Therapy, Reduce Treatment Time E-mail
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A study of the first approximately 100 patients who have received partial breast irradiation with a small, whisk-like, expandable device inserted inside the breast has shown that after one year, the device is effective at sparing nearby healthy tissue from the effects of radiation.

The device, called SAVITM, is aimed at providing customized radiation therapy while minimizing exposure to healthy tissue around the breast after a woman has received a lumpectomy for early stage cancer.

The findings, reported recently at the American Society of Clinical Oncology's 2008 Breast Cancer Symposium held in Washington, D.C., showed that nearly half of the women, because of their anatomy or the location of the tumor, would not have qualified for other such similar internal radiation therapy techniques and would have likely needed a much longer course of therapy.

The device is another option for women with early breast cancer who have received a lumpectomy to remove a cancer. Radiation specialists sometimes opt to give women internal radiation - a process called brachytherapy - with the goal of giving concentrated doses of radiation to areas of concern while avoiding healthy tissue such as the heart, lungs, ribs and skin.

In the study, the researchers found that the Food and Drug Administration-approved SAVI, which consists of flexible catheters through which radiation is given, is easy to use and enabled them to change the dosages according to the woman's needs. They saw very little radiation burning of the skin and a low infection rate. In addition, it allows women to have treatment twice daily for five days rather than daily for six weeks.

"The problem with other internal radiation methods is that women with small breasts, or with a tumor bed near the breast surface, would get skin burns with the standard device," said Catheryn Yashar, M.D., assistant professor of radiation oncology and chief of breast and gynecological radiation services at the Moores Cancer Center at the University of California, San Diego, who led the work. "The SAVI device was created to overcome those downsides. It enables specialists to shape the radiation to the shape and size of the woman's tumor and still miss healthy tissue.

"These findings emphasize the fact that we could expand the patient population eligible for partial breast irradiation because of the SAVI," Yashar said.

In recent years, a balloon-like device called the MammoSite has been increasingly used to deliver radiation therapy internally after lumpectomy. Another technique, called interstitial irradiation, involves the use of needles in the breast and has gained some popularity as well. But according to Dr. Yashar, neither device has been proven superior to whole breast irradiation for local and regional control of early breast cancer.

"Partial breast irradiation is in its infancy," she said.

"Of the patients we've treated here, 30 to 40 percent would not have been eligible for a MammoSite (a balloon device) and wouldn't have otherwise been treated by partial breast irradiation this way," noted Daniel Scanderbeg, Ph.D., a resident in medical physics in the department of radiation oncology. The reported results involve the first 102 patients seen at the Moores Cancer Center, Arizona Oncology Services and the Breast Care Center of the Southwest, both in Phoenix, AZ.

The SAVI breast brachytherapy applicator is made by Cianna Medical, Inc. The Moores UCSD Cancer Center was one of the first medical facilities in the nation to offer SAVI.

Yashar thinks that SAVI or devices like it could become the standard eventually for radiation therapy for early breast cancer, though it is still early on in its testing. Radiation oncologists at the Moores UCSD Cancer Center have begun teaching others about device placement and radiation treatments.

Other authors include Anne Wallace, M.D., professor of clinical surgery, Sarah Blair, M.D., associate professor of surgery, UC San Diego; Coral Quiet, M.D., Salih Gurdalli, Ph.D., and Robert Kuske, M.D., Arizona Oncology Services; and Victor Zannis, M.D., Breast Care Center of the Southwest.

The Moores Cancer Center is located at the University of California, San Diego. Founded in 1979, the Center is one of just 41 centers in the United States to hold a National Cancer Institute (NCI) designation as a Comprehensive Cancer Center. As such, it ranks among the top centers in the nation conducting basic and clinical cancer research, providing advanced patient care and serving the community through outreach and education programs. For more information, access http://cancer.ucsd.edu/.

About Breast Cancer

Breast cancer is a malignant (cancerous) tumor that starts from cells of the breast. The disease occurs mostly in women, but men can get breast cancer too. In the U.S., it affects one in eight women. There are many types of breast cancer, though some of them are very rare. Sometimes a breast tumor can be a combination of these types and to have a mixture of invasive and in situ cancer.  The most common types of breast cancer are: 

  • Ductal carcinoma in situ (DCIS): This is the most common type of non-invasive breast cancer (85 - 90% of all cases). DCIS means that the cancer is only in the ducts. It has not spread through the walls of the ducts into the tissue of the breast. Nearly all women with cancer at this stage can be cured. Often the best way to find DCIS early is with a mammogram.
  • Lobular carcinoma in situ (LCIS): This condition which occurs in approximately 8% of all cases, begins in the milk-making glands but does not go through the wall of the lobules. Although not a true cancer, having LCIS increases a woman's risk of getting cancer later. For this reason, it's important that women with LCIS to follow the screening guidelines for breast cancer.

Less common are: 

  • Inflammatory breast cancer (IBC): This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead, inflammatory breast cancer (IBC) makes the skin of the breast look red and feel warm. It also gives the skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or infection, but by cancer cells blocking lymph vessels in the skin. The breast may become larger, firmer, tender, or itchy. IBC is often mistaken for an infection in its early stages. Because there is no defined lump, it may not appear on a mammogram, which may make it even harder to catch it early. It usually has a higher chance of spreading and a worse outlook than invasive ductal or lobular cancer.
  • Paget's disease of the nipple. Paget's disease of the nipple or breast is a rare type of breast cancer, which can occur in women and men. It shows up in and around the nipple, and usually signals the presence of breast cancer beneath the skin. Most cases are found in menopausal women, but can also appear in women that are as young as 20.  Early stages symptoms include redness, scaly and flaky, and  mild irritation of  nipple skin. Advanced stages may include: tingling in nipple skin, very sensitive skin on the nipple, burning or painful nipple skin, ooze or bloody discharge from the nipple (not milk), itchiness that doesn't respond to creams, nipple retraction (pulls into the breast), scaly rash on areola skin, and/or breast lump beneath the affected skin.

Symptoms of breast cancer may include: 

  • a lump or a thickening in the breast or in the armpit. Note Most breast lumps are benign (be-nine); that is, they are not cancer. Benign breast tumors are abnormal growths, but they do not spread outside of the breast and they are not life threatening. But some benign breast lumps can increase a woman's risk of getting breast cancer. Most lumps turn out to be caused by fibrocystic (fi-bro-sis-tik) changes. Cysts are fluid-filled sacs. Fibrosis is the formation of scar-like tissue. Such changes can cause breast swelling and pain. The breasts may feel lumpy, and sometimes there is a clear or slightly cloudy nipple discharge.
  • a change of size or shape of the mature breast
  • fluid (not milk) leaking from the nipple
  • a change of size or shape of the nipple
  • a change of color or texture of the nipple or the areola, or of the skin of the breast itself (dimples, puckers, rash)
  • a discharge from the breast


 

 
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