Side Effects of Mammosite Radiation Therapy
Comments
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redsox, if I'm reading this right, the report is saying that IBTR is "unsuitable" for any patient who is 50 years of age or younger, and also is "unsuitable" for any patient who has Stage 0 DCIS that is >3cm in size. And IBTR is "cautionary" for anyone with pure DCIS of any size, and for anyone under the age of 60.
Very interesting! I knew that there were controversies but I did not know that.0 -
Hi Bessie, Aren't initials fun and confusing?????
You mentioned IBTR. I think that means Ipsilateral breast tumor recurrence.
You probably were referring to APBI (Accelerated partial breast irradiation).
My radiologist told me that the important thing was to follow the best research protocol available for our situation, then not look back or worry about our choice. After we do the best we can, we can leave the future up to God.
Hopefully, there will not be problems, but if they come along, God will be with us as we go through them!0 -
Yes, Sonnie, I meant APBI. Thank you for catching that!0 -
Yes, for APBI they are looking for patients who have a low risk of recurrence, but especially those with low risk of recurrence outside the immediate area of the original cancer. The rationale for APBI is that most recurrences occur near the original site so targeting that area only gets those. But it does leave the rest of the breast untreated. Those with higher risk in general include younger patients. Those with higher risk outside the original site include those with larger cancers or multi-centric or multi-focal. I think most of us would be surprised that DCIS is not the stage best for APBI but a small T1 cancer without much DCIS alongside is. That is because DCIS is more likely to spread more widely in the breast.0 -
Redsox, that is interesting info.
I have trouble understanding why APBI doesn't effectively treat the whole breast (although I know the data says it doesn't).
4-5 months after radiation I had a little skin flake off one side of my other breast and my back directly behind my radiated breast. We could only assume that radiation had caused that.
My BS is now doing frequent IORT. I wanted to have that done, but insurance will not pay for that one dose of radiation during the cancer surgery for DCIS because the studies done with IORT were only done with invasive cancer.0 -
APBI only treats part of the breast because that is how far the radiation goes. With brachytherapy they use internal radiation sources implanted in the breast. Each radioactive seed emits radiation and the whole set of seeds is arranged to target the area they want to treat to the desired dose level. Each type of source has a predictable pattern of how much radiation is delivered for how much of a distance out from the seed. The treatment planning process involves figuring out the best arrangement of sources in each treatment to get the pattern of dose that they want. Brachytherapy is used for small areas because the radioactivity only extends a short distance.
Similarly, external beam radiation involves planning how to arrange the beams from the linear accelerator so that the path of the beam delivers the desired dose to the target area over the course of treatment. This can be used for larger areas such as the whole breast. With newer high technology methods such as Intensity Modulated Radiation Therapy (IMRT) the pattern of dose can be delivered to a variety of shapes of the target area, and IMRT is also a method used for partial breast irradiation.
When they decide which patients are good candidates for APBI they are looking for people at low risk of recurrence, especially in the part of the breast that would be treated by whole breast irradiation but not by partial breast irradiation.
There is some scatter of small amounts of radiation beyond the target area and that might cause skin flaking elsewhere. I wouldn't expect that on your back if you were treated for DCIS. It would be more likely for someone who had nodal areas treated.0 -
Smerrill.....I am so amazed that you developed the SAME superficial thrombosis and cord running from your breast to your belly as I did....I have exactly the same thing. Radiation doctor has no ideas to help me, surgeon says no big deal, just live with it, oncologist treated me with low dose blood thinners that I administer my self with shots in the belly. Looked it up on the internet and it's called Mondor's Disease The pain in the breast did improve somewhat after with the blood thinners, but the cord has not gone. Now, 11 days later,oncologist instructed me to stop the blood thinner shots, and see how things are in two weeks. Can you tell me did the vascular doctor say to do about it. Still have pain and I CANNOT wear a bra or anything that presses against my ribs just below my breast. I asked If perhaps I had a fractured rib, and could we investigate that possibility, but no interest in further investigation by my doctor. Any idea what the treatment is for rib fracture? Any thoughts or information you can give me about what you did, what your doctors said, etc. would be of great interest to me.
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Hi all,
I had DCIS stage0 in Sept of 2008. I am now over 5 years out and still experiencing breast pain and occasional armpit pain. I had mammosite radiation and have many of the same complaints you do. I have a hard lump where the radiation was, sometimes a pinching almost nerve pain low around my bra area, and the pain can last for months and go away. I may have cysts in there but none of my mammograms have ever picked it up. Any recommendations for pain management other than aspirin? My radiologists recommended anti-inflammatory meds. Would I do it again? Yes, I think I would. They told me I had only a 15% risk that it would ever return and I don't have any burnt skin issues. I have very large breasts though so there was plenty of insulation. I was so relieved to find this site as the pain has been a constant concern. Scheduled for a mammogram in 2 weeks.
I will keep checking in! Blessings all!
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I had external beam partial breast irradiation last April for a very small DCIS (5mm) and this was through Yale and it was a clinical trial. I had 38.5 grays over a 5 day period, 2 x a day, 6 hours apart. I am happy to report that I have no real lasting side effects. I did not burn at all but I did experience extreme fatigue that lasted over 3 months after I finished. I am being monitored every 6 months for cosmesis/cosmetic concerns as women who have had this have reported less cosmetic happiness than women who have done whole breast rads.
Since my breasts are small, my RO said most of my breast was radiated anyway, but the short course was what made me opt in.
I am still happy with my decision 9 months later.
here is a link to the study http://medicine.yale.edu/cancer/patient/trials/available/OnCore1110009173-2.trial
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Hi mammosite momma,
I am 20 months out from my mammosite therapy. I have developed a hardness in the area where the balloon was placed. It can very painful at times. Wondering if I should call my BS to ask for some pt. I had a MRI last June and a mammogram and U/S in December. Just saw my rad onc on Wednesday for a check up. No one seems concerned about it, but it bothers me.
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Hi OkieMomof 4 and anyone else on this blog who is experiencing side effects of the Mammosite. I know you don't have time to read a lot of the messages on this blog, but as a breast cancer survivor starting her eighth year, I feel qualified to comment about almost any experiences with Mammosite, because I have experienced quite a few. It is very normal to feel a mass or hardness in your breast because you healed normally without stitches and air pockets formed and caused masses or tissue to attach themselves to your surgical scar. As I started to heal from my surgery years ago, I had a cyst drained and it came back again. As the years have gone on, I have a definite mass in my breast and it has attached itself to my surgical scar. It used to be soft, but as of late, it has become hard and is uncomfortable at times. I have been told by my oncologist that there is no breast cancer, but last year when I had my mammogram, they were very thorough and even did an ultrasound. Right now, I am hoping because the hardness is all around my surgical scar that it is scar tissue. We must be very observant as many of us had Mammosites when they were first being used. Don't be afraid to ask questions of your doctor. If they tell you you will have to live with the pain, etc., be thankful because you are a survivor. I am very blessed and I am thankful.
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Hi BBJ,
Thanks for the encouragement. I appreciate your words about being a survivor. I guess I was looking at the pain in a negative light, as I was seeing it as a daily reminder that I had breast cancer. Perhaps, I should view it as a daily reminder that I beat breast cancer.
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14 months after my mammosite I began having pain slightly below and behind my radiated breast. I made the mistake of assuming that it was the normal pain due to mammosite radiation. I checked with a doctor who did a mammogram and ultrasound without finding anything. The pain lasted about a month. Two months after the pain stopped, a routine MRI showed enhancement on my rib. That was followed by an xray that showed a healing, fractured rib. I had done nothing to break the rib. It had hurt to breathe and move in certain ways, but was not terribly painful like I expected a broken bone to be. My surgeon told me that mammosite pain is common but is not made worse by a deep breath. My radiology oncologist said ribs can be damaged by the radiation, but do strengthen through time. He said to be careful lifting things - not over 20 pounds.
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Sonnie....It is good to hear from you despite your unfortunate news. I appreciate your remembering us sisters as you continue your journey. Hope this is just a bump in the road and you find your way back to normal soon!
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Dear Members, Can you lend your voice. If you have been diagnosed with DCIS or Stage I breast cancer and have considered or completed radiation therapy, please take 5 minutes to complete this brief survey.click here to take survey Thanks for your help.The Mods
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Moderators:
Please identify yourself to us and let us know why you are taking this survey? Who is it for and what do you intend to use it for? I have been on this blog a long time and have never seen any topics from you. As you can see from this blog, many of us have been diagnosed with DCIS Stage 1 breast cancer.
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You mean the moderators? They run this web site.
I might mention DCIS is always stage zero by definition. If you do indeed have stage one, then it is not DCIS.
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Wanted to share some information with you all who have had Mammosite surgery: Just went for my annual mammogram after being breast cancer free for eight years. All year felt something just above my lumpectomy surgical scar. After a couple of tries with the mammo, I was pronounced breast cancer free. There was a "lump" or "wad" that had formed on the scar tissue and it was suspicious for some time. I was told that as we age, scar tissue from Mammosites shifts around in our breast on a regular basis and can form "cyst-like" lumps. Also, one week before I had my mammo, I went off caffeine entirely and was better able to tolerate the mammo in my sensitive area. Just wanted to share this with those of you who may be concerned about what's going on in your body. Don't be afraid to ask questions. I wanted you all to know that I am so thankful. Because of my strong faith in God, I am a survivor thriver and you are too!
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BosomBuddy. . . Praise God that you are a survivor thriver and the 'wad' is not cancer. Thanks for the scar tissue info, and all the encouraging info, you share with us.
My surgeon told me it is important to do breast massage in the area where the mammosite scaring is. I have been doing that for almost two years now and have been surprised by the way the lump changes and moves around. It has been worrisome. I was planning to ask about that when I have my next mammo in Sept. Thanks for sharing your story. I probably have nothing to be concerned about.
I also have strong faith in God and love the song 'Still'. These words from the song are my comfort when the storms of life feel threatening: "When the oceans rise and thunders roar, I will soar with You above the storm. Father You are King over the flood I will be still and know You are God".
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I think it's pretty common to have a "wad" of scar tissue, whether you have mammosite or not with a lumpectomy.
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shayne...I most respectfully and humbly disagree.
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I'll have to agree with voraciousreader. My lumpectomy scar is almost impossible to find unless you know exactly where to look. No sign of scar tissue.
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Hi Everyone:
Thanks for all your comments. Shayne, what's your diagnosis? You don't even indicate that you had breast cancer surgery in your past statements on this blog.
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In 2009, I had a partial mastectomy and 33 radiation treatments, eight of which were boosts. I have a "wad" of scar tissue behind my incision scar that feels a lot like a gum eraser beneath the skin. It is also tender to the touch, even 4+ years out. My oncologist calls it fibrosis and I attribute it to the boost treatments.
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See comment in PubMed Commons belowJ Am Coll Surg. 2013 Sep;217(3):497-502. doi: 10.1016/j.jamcollsurg.2013.03.028. Epub 2013 Jul 2.
Increased rates of long-term complications after MammoSite brachytherapy compared with whole breast radiation therapy.
Rosenkranz KM1, Tsui E, McCabe EB, Gui J, Underhill K, Barth RJ Jr.
Author information
- 1Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. kari.m.rosenkranz@hitchcock.org
Abstract
BACKGROUND:
Due to its short duration of therapy and low rates of local recurrence, women undergoing breast conservation are increasingly opting for partial breast irradiation with the MammoSite (Cytyc/Hologic) catheter. In early follow-up studies, few complications were reported. Few data, however, exist regarding longer-term complications. We compared the long-term local toxicities of MammoSite partial breast irradiation with those resulting from whole breast radiation.
STUDY DESIGN:
This was a retrospective study performed in a single academic medical center. All patients who underwent breast-conserving surgery between 2003 and 2008, who met institutional criteria for brachytherapy, were included. We compared women treated with MammoSite with patients treated with whole breast radiation therapy (WBRT). Endpoints included incidence of palpable masses at the lumpectomy site, telangiectasias, and local recurrence.
RESULTS:
Seventy-one MammoSite patients and 245 WBRT patients were well matched with regard to clinical characteristics. Median follow-up was 4 years. A palpable mass developed at the site of lumpectomy in 27% of the MammoSite patients compared with 7% of the WBRT patients (p < 0.0001). Telangiectasias developed more frequently in the MammoSite group than in the WBRT group (24% vs 4%, p < 0.001). Forty-two percent of patients treated with MammoSite developed a palpable mass, telangectasia, or both.
CONCLUSIONS:
Palpable masses and telangiectasias are frequent long-term complications after MammoSite brachytherapy and occur at a significantly higher rate after MammoSite brachytherapy than after WBRT. This increased rate of long-term local toxicity should be considered when counseling women on options for adjuvant radiation therapy after breast-conserving surgery.
Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
APBI; BCT; WBRT; accelerated partial breast irradiation; breast conservation therapy; whole breast radiation therapy
- PMID:
- 23830216
- [PubMed - indexed for MEDLINE]
- PMCID:
- PMC3808115
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I had Partial breast rads 2X a day for one week at very high grays, but with conformal external beam (same as those that have full breast rads) and have a little bit of a hard area near my lumpectomy scar but it is not a lump..just a bit hardened. Not sure if this is due to rads or what but thought I would mention it.
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Hello Bosom Buddies:
Thanks for all your responses. I want to especially thank voraciousre for her medical submission and consideration for our concerns. Wouldn't it have been nice for all of us if we had been told about this during that time? I still would have opted for Mammosite as I believe in challenges and I can do anything with the grace of God who is in me and directs me. I am feeling great after my recent diagnosis and I believe I am on target with my new doctor.
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Hi! I thought you might like to know that I, too, am a two year survivor of breast cancer and I, too, received mammocyte radiation....and yes, I still also have some tenderness and some hard scar tissue around the site. My doctors say that this is totally normal! So, not to worry. Just keep up with your routine surveillance appointments, OKAY ? Be joyful!0 -
Please ask to have a yearly breast ultrasound AS WELL AS a yearly mammography (and yearly MRI, if possible). Sometimes a mammography can be negative due especially to dense breasts, but the ultrasound can pick it up! Very important, it saved me...as my mammo was negative, but my ultrasound was positive. I am now a 2-year breast cancer survivor and have a yearly mammo, ultrasound and MRI. We are so blessed to have such great surveillance!Be well and joyful!
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I also have "markers" still in my breast from where they marked the biopsy site.....i had several cysts. One of the cysts was malignant. I had DCIS, lx was may of 2012
just felt my breast, guess it's been awhile, but i dont feel any scar tissue any more.... just a boob
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