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.

Continue Reading

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. 


1. American Cancer Society. Cancer Facts & Figures 2011. Atlanta, GA: American Cancer Society Inc; 2011. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-029771.pdf. Accessed July 9, 2013.

2. Phenomenal woman A history of breast cancer. Random History Web site. http://www.randomhistory.com//1-50/029cancer.html. Posted February 27, 2008. Accessed July 1, 2013.

3. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233-1241. doi:10.1056/NEJMoa022152

4. McCormick B. Partial-breast radiation for early staged breast cancers: Hypothesis, existing data, and a planned phase III trial. J Natl Compr Canc Netw.2005;3(3):301-307.

5. American Society for Radiation Oncology. Whole breast irradiation guidelines released. Science Daily Web site. http://www.sciencedaily.com/releases/2010/08/100804133450.htm. Published August 9, 2010. Accessed July 1, 2013.

6. Gandey A. Hypofractionated breast radiotherapy appears effective. Medscape Medical News Web site. http://www.medscape.com/viewarticle/558653. Published July 21, 2007. Accessed July 1, 2013.

7. Biagioli MC, Harris EE. Accelerated partial breast irradiation: potential roles following breast-conserving surgery. Cancer Control. 2010;17(3):191-204.

8. Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractioned radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513-520.

9. Chao KK, Vicini FA, Wallace M, et al. Analysis of treatment efficacy, cosmesis, and toxicity using the MammoSite breast brachytherapy catheter to deliver accelerated partial-breast irradiation: The william beaumont hospital experience. Int J Radiat Oncol Biol Phys. 2007;69(1):32-40. doi:10.1016/j.ijrobp.2007.02.026

10. Polgár C, Major T, Fodor J, et al. High-dose-rate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast-conserving surgery: seven-year results of a comparative study. Int J Radiat Oncol Biol Phys. 2004;60(4):1173-1181. doi:10.1016/j.ijrobp.2004.05.012. 

11. McCormick B. Partial breast radiation for early-stage breast cancer. Curr Opin Obstet Gynecol. 2012;24(1):31-37. doi:10.1097/GCO.0b013e32834d4aaf .

12. Benitez PR, Keisch ME, Vicini F, et al. Five-year results: The initial clinical trial of MammoSite balloon brachytherapy for partial breast irradiation in early-stage breast cancer. Am J Surg. 2007;194(4):456-462. doi:10.1016/j.amjsurg.2007.06.010

13. Vicini F, Beitsch P, Quiet C, et al. Five-year analysis of treatment efficacy and cosmesis by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in patients treated with accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2011;79(3):808-817.

14. American Society of Breast Surgeons. Consensus statement for accelerated partial breast irradiation. http://www.breastsurgeons.org/statements/PDF_Statements/APBI.pdf. Accessed July 1, 2013.

15. Arthur DW, Vicini FA, Kuske RR, et al; American Brachytherapy Society. Accelerated partial breast irradiation: an updated report from the American Brachytherapy Society. Brachytherapy. 2003;2(2):124-130.

16. Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74(4):987-1001.

17. Patel PS, Nori D, Monni S, et al. Outcomes of patients in ASTRO’s cautionary group treated with accelerated partial breast irradiation (APBI). Int J Radiat Oncol Biol Phys.2010;78(3 suppl):S220.

18. Vicini F, Arthur D, Wazer D, et al. Limitations of the American Society of Therapeutic Radiology and Oncology Consensus Panel Guidelines on the use of accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2011;79(4):977-984.

19. Zannis V, Beitsch P, Vicini F, et al. Descriptions and outcomes of insertion techniques of a breast brachytherapy balloon catheter in 1403 patients enrolled in the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Am J Surg. 2005;190(4):530-538.

20. Scanderbeg DJ, Yashar C, Rice R, Pawlicki R. Clinical implementation of a new HDR brachytherapy device for patial breast irradiation. Radiother Oncol. 2009;90(1):36-42.

21. McCormick B. Hypofractionated whole breast radiation and partial breast radiation for early-stage breast cancers: an update on progress. J Natl Compr Canc Netw. 2012;10(9):1161-1164.