A radiation-planning visit commences once histopathology is acceptable and the ALC is in place. CT scans of the chest/breasts are utilized by the physics department to create an individualized radiation treatment plan.20 The recommended timing for the CT is approximately 24 hours after the ALC is placed, allowing for air to escape from the cavity.
The actual treatment can begin shortly thereafter and involves a short (15-30 minute) treatment twice a day for 4 or 5 days. The treatments are separated by 6 hours. Catheter position is verified via radiography or CT prior to each treatment. When the final treatment is completed, the balloon is deflated or, in the case of the SAVI, the struts are dialed down, and the device is removed.
Potential side effects from partial breast HDR utilizing an afterloading catheter include infection, seroma, fat necrosis/tissue fibrosis, radiation pneumonitis, or poor cosmesis (volume loss, tissue retraction, contour defect, telangiectasia).20,21 National Comprehensive Cancer Network (NCCN) follow-up guidelines for breast cancer recommend a clinical examination every 4 to 6 months for 5 years, and annually thereafter. Mammography is recommended every 6 to 12 months postradiotherapy or every 12 months if no radiation was indicated. Women with an intact uterus who are taking tamoxifen are advised to undergo a yearly gynecologic examination. Women who are taking an aromatase inhibitor or who have early menopause should have a periodic bone density scan.
In light of the number of women with breast cancer and that women are living longer with treatment, it is difficult to not be touched by breast cancer in some manner. As advanced practitioners, we are charged with striving to stay informed of the current science and how it affects our patients. Our role is to be educators and counselors, as well as caregivers and prescribers.
Women with breast cancer have more treatment options than at any other time in history. Current studies indicate that outcomes from accelerated partial breast irradiation are statistically equivalent to those of whole breast irradiation for a select population of women. The APBI device received FDA-approval 10 years ago, and the NSAPB study (B-36), a comparison study of APBI versus WBI, will begin analyzing data. The next 5 to 10 years will be very telling as to whether the current treatment technology and patient selection criteria can stand the test of time. The analysis of new data may spawn new devices or further refine the selection criteria for appropriate candidates for APBI. Regardless, current indicators suggest this treatment modality will be enduring, and likely gain further acceptance and accessibility. ONA
Kim Mullins is a nurse practitioner at Oncology Hematology Care in Cincinnati, Ohio, and on the faculty at The University of Cincinnati College of Nursing.
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