Mammosite Experience?

[Lee]

I have just been diagnosed with breast cancer. In meeting with one surgeon, he said that I would be a good candidate for Mammosite radiation therapy, however, another doctor I spoke with did not think very highly of this type of treatment, a third doctor did not think I would be a candidate. I am trying to collect more information and wondered if anyone had any thoughts, other than the shorter time frame that this radiation treatment offers.

Any help would be most appreciated. -- Lee

[Sandy H.]

What type of radiation is this? I have never heard of it. Where do they do this? Hugs, Sandy

[Janet/FL]

Hi Lee
I was going to have Mammosite as the tumor was small, but when tests came back as HER2 +++ that was canceled so that I could have chemo before regular radiation. I did not opt for the chemo so I could have had it. Do you know anything about your tumor? Size, ER,PR and HER2 status? If any lymph nodes appear postive you could not have it either.
Mammosite is where a balloon is inserted into the cavity made when tumor is removed. Radiation therapy directly into the site is given for about 3 days, twice a day, then followed usually by about 4 weeks of radiation with no boost at the end as the boost is at the beginning. At least that was the schedule I would have been on.
Janet/FL

[Lee]

Dear Sandy and Janet,

I’m sorry it’s taken so long for me to respond to your responses, but to be quite honest, I am a novice when it comes to these boards, and I wasn’t sure how to get back to the posting. Luckily I printed out the response and someone suggested that I just type in the long string of letters and numbers at the bottom of the page.

What Janet said in her response is generally correct. It is a shorter course of radiation therapy used with radiation seeds. I was told mine would be twice a day for five days. If you go to www.mammosite.com it explains the procedure in full.

Since I posted my question, I sought out an opinion from a radiation oncologist. He felt that I would NOT be a candidate for the therapy. I was satisfied with his explanation but have run into some problems in conveying my interest in having the external beam radiation treatment to my surgeon’s office. This is causing me additional stress which frankly I don’t need. It has made me wonder whether I should be seeking another surgeon.

I will try to figure out how to use this board. It looks very interesting and by your responses, it seems like it could be very helpful.

Thanks very much for your input and good luck to you both.

Lee

[suz777]

Hi, all! I'm new to this, but did have APBI (abbreviated partial breast irridation) via use of the Mammosite procedure last week.

I had a lumpectomy on a Thursday 10/26/6 (1.1cm tumor); one week later, they took me back to the operating room to insert the catheter with a balloon at the end into the tumor bed, inflated the balloon with saline (that's as close as I'll probably get to an actual breast implant at this point), did a CT scan the next day to ensure the balloon was properly placed and holding OK, that there were no air pockets between balloon and cavity in my breast. Then, I had radiation 2x a day for 5 days...the next Mon-Fri. I went to work most days in between treatment and the balloon and catheter were pulled out following my last treatment.

The staff was wonderful; I got to play my own music at each treatment session. Targeted Xrays were taken of that breast immediately prior to each 'dose.'

Not everyone qualifies for Mammosite and it is not available everywhere and is generally more expensive. Your tumor has to be a certain size, as does your breast. Large tumors and/or small breasts don't stand a good shot at working here.

www.mammosite.com (http://www.mammosite.com/) does have lots of info on this; if you click around enough places you can get to a place to see a little animated demo of the procedure also.

Some doctors insert the balloon and catheter along with the lumpectomy. Others do it later, waiting for the pathology to come back to ensure your margins are clear and nodes negative; why put all that in you if they just have to take it out? On the other hand, waiting does involve another mini-surgery or some doctors do it under local in their office. It just depends, ASK!

I had only a little redness, slight nausea once or twice, and I needed some extra naps. You have to wear a special bra to accommodate the catheter and gauze. But it's all manageable! Most of my appts were at 9am and 3pm.


Suzanne
Los Angeles
10/03/6 DX
10/26/6 lumpectomy
Nodes negative, margins clear
1.1cm tumor
ER/PR positive; HER2neu negative
Lymphovascular invasion

[karenann]

Hi,

I was wondering if I read your stats correctly. Did you have lymphovascular invasion? If so, did they give you chemo?

Karen

[suz777]

Karen,

The path report and my surgeon did say my tumor had lymphovascular invasive qualities, that's the main thing that wasn't good about it. That's part of why they really preferred whole breast irridation as opposed to partial, but only because there's not enough long term data yet on the effectiveness of partial vs whole for this feature. They left it up to me and I picked partial.

I'd been checking other sites for recommendations re: lymphovasculuar invasion, but hadn't found much. The tumor's gone, margins clear and nodes negative. I plan to do some holistic cleansing to boost my immune system and am looking into natural cancer killing treatments also. But they didn't say chemo was an automatic yes due to this either. What do you know or what has your experience been??? (No chemo yet...)

Suzanne

[Ruth T]

hi, I was diagnosed July 2006. I had a lumpectomy and mammosite. My surgeon put the cath in in his office. Went to the hosp for 5 days about 8 and 2 each day. Had a ct scan before the actual radiation to make sure everything was in place. The actual radiation time was about 8 minutes. After the last treatment the radiation onc removed the catheter.Since this was only approved in 2002 there are not a whole lot of drs. doing it. I live in a suburb of Chicago where there are about 3(including mine) doing it. It did postpone my chemo abit, but maybe since I'm stage 1 no nodes it was okay. I had a good experience with it. According to what my surgeon said recurrences are low from studies so far. It may be too soon to tell, but the actual prodedure just made sense to me. You have to go with your own instincts. Ruth T

[Lani]

ABSTRACT: Clinical experience with the MammoSite® radiation therapy system for brachytherapy of breast cancer: Results from an international phase II trial [Radiotherapy & Oncology]
Background and purpose: In a prospective multi-center phase II trial, we investigated the MammoSite® Radiation Therapy System, a new device for delivering intracavitary brachytherapy following breast conserving surgery. The MammoSite® is a dual lumen, closed ended catheter with a small, spherical inflatable balloon and a port for connecting a remote afterloader to the central lumen. We analyzed the surgical procedure and placement of the MammoSite®, treatment planning and radiation delivery complications and cosmesis, as well the comfort for the patients.

Patients and methods: Between 2002 and 2004 a total of 32 patients (pts) were implanted using the MammoSite®. The reference isodose was defined 1 cm from the balloon surface. We analyzed the post-implant anatomic position of the applicator and the geometric form of the balloon via ultrasound, CT and X-ray, related side effects, cosmetic outcome and patient quality of life.

Results: Twenty-three out of 32 patients (72%) were eligible for MammoSite® intracavitary brachytherapy. Twenty-eight percentage had to be excluded because of different reasons. Eleven patients were treated with primary brachytherapy with a total dose of 34 Gy (2 x 3.4 Gy) and 12 had a boost with a mean dose of 13.3 Gy (range: 7.5-15 Gy; 2 x 2.5 Gy) combined with EBRT and doses ranged between 46 and 50 Gy. In three cases a balloon rupture occurred. We observed two abscesses within 3 months of implantation and serious seroma development in 10 patients (39%). Skin related side effects were erythema in 21 patients (91%), hyperpigmentation in 13 patients (56%) and teleangiectasia in six patients (26%) after mean follow-up 20 months.

Conclusions: The MammoSite® Radiation Therapy System is a feasible treatment modality for intracavitary brachytherapy of breast cancer after breast conserving surgery. The advantage of the system is only one applicator is necessary for the delivery of a fractionated radiotherapy. In addition, patient tolerance of the procedure is high. Critical issues concern possible overdosages at the skin reflected by a high rate of late skin damage after only 20 months of follow-up time. The method could serve as an alternative to conventional multi-catheter brachytherapy for a selected group of patients.

[Lani]

I see you are not her2+(no bigee!), but just to let you know so far I have found what seem to be the only two papers specifically discussing whether her2 tumors recur more frequently locally than others after radiation therapy--they do not appear to.

Hard to find similar papers on LVI, although the general assumption is that if the tumor is aggressive enough to have shown signs of "escape" already it might be more likely to recur somewhere else in the same breast. THAT might theoretically be a reason to have whole breast irradiation (external beam) rather than partial breast irradiation (mammosite, other brachytherapy techniques or external APBI),but again, I haven't yet found a paper that
discusses that specifically.

Let me know if anyone else has. Hope this helps!

ALSO whole breast radiation treats the bottom-most lymph nodes in the armpit even without a lymph node boost from what I understand--which is probably why they only let node negative patients into most APBI trials

[suz777]

Thank you for the post; sorry, I'm about 3 weeks behind in my email, apparently! The info was helpful.

Suzanne