John Stoddard Cancer Center
An Easier Way to Receive Radiation Therapy
If you were looking for a story that perfectly illustrated the different stages of a breast cancer journey, Deborah Langner's would be it. While each person's experience with the disease is different, the 57-year-old wife and mother's breast cancer journey includes many of the typical elements: mammography, lumpectomy, radiation therapy and thankfully, remission. For Deborah, however, it was a not-so-typical radiation technique that made all the difference.
The Early, Iowa resident had gotten a mammogram every year since age 42, but in August 2008, a change in insurance forced her to search for a different screening destination since her preferred radiologist in Sioux City was no longer a covered provider. She considered visiting the radiology department at her local hospital, which had just acquired digital mammography.
"Just for a second, I thought about not even having a mammogram that year," Deborah says. "Thank goodness I did, however, because an abnormality was found in my left breast. The news was surprising, but there is a history of cancer in my family. One first cousin had breast cancer in her late 30s, while another had brain cancer in her 40s. An aunt also had ovarian cancer."
A stereotactic biopsy performed in Deborah's hometown confirmed that she had a type of breast cancer called invasive ductal carcinoma, the most common form of the disease that originates in the lining of a milk duct and invades surrounding tissue. Deborah decided to pursue breast conservation rather than mastectomy, and in September 2008, the cancerous tumor was removed via lumpectomy. A re-excision was performed two weeks later to remove a little more of the surrounding tissue.
Accelerating the Treatment Process
For many patients who choose breast conservation, lumpectomy is the easy part. The most difficult leg of the cancer journey is the physically and emotionally draining odyssey of radiation therapy, which usually entails approximately six weeks of daily treatment with external beam radiation. The surgeon in Deborah's hometown, however, suggested an alternative: accelerated partial breast irradiation (APBI).
APBI holds a wealth of benefits for patients, including the short amount of time it takes to complete treatment compared to external beam radiation. APBI is conducted twice daily during five consecutive business days. If a patient is deemed a candidate for the treatment, a temporary balloon catheter is placed into the lumpectomy cavity following surgery. The temporary catheter remains in place for a couple days until the surgeon and radiation oncologist review the patient's final pathology results to make sure the margins of healthy tissue surrounding the tumor site are of appropriate size and checks to be sure the lymph nodes are cancer free. After the surgeon replaces the temporary catheter with a treatment version, the patient sees the radiation oncologist the next day to begin planning for radiation delivery and undergo a computed tomography (CT) scan of the lumpectomy site.
The following day, treatment begins after another CT scan to make sure the catheter hasn't shifted position. At John Stoddard Cancer Center at Iowa Methodist Medical Center, patients can undergo APBI using one of three catheters: Contura™, MammoSite® and SAVI™. The size of a patient's breast, as well as the size and location of the tumor, determines which applicator is best to use. After the catheter in the patient is connected to the remote afterloader, the radioactive source-a capsule on the end of a cable that's coiled up inside the afterloader-spools out and enters the balloon catheter inside the patient's breast. Once inside the breast, the source delivers radiation for a specified amount of time based on the size of the tumor, typically approximately five minutes. Finally, the cable coils back into the afterloader, removing the radioactive source from the catheter, and treatment is finished. The twice-daily treatments are usually performed at six-hour intervals.
"APBI can be completed within two weeks after the lumpectomy, which spares patients the typical four-week wait for external beam radiation following surgery," says Robert Isaak, MD, radiation oncologist at John Stoddard. "APBI allows radiation oncologists to better protect healthy tissues from radiation, and for patients, the treatment typically causes less fatigue and less risk of a skin reaction than traditional radiation. The convenience of APBI is also a big factor for many women. Patients who live in rural settings often choose mastectomy for simple expediency. APBI opens up the option of breast conservation to a wider range of patients because it takes only one week to complete."
Open to Innovation
At her surgeon's suggestion, Deborah researched APBI after her lumpectomy and decided it sounded like a good option for her.
"I've always been open to new technology," she says. "My surgeon initially referred me to a nearby facility to receive APBI, but another change in insurance forced me to search for an alternative treatment destination after I'd already had a catheter placed in my breast. Dr. Isaak and his staff graciously welcomed me to John Stoddard, where I was the first patient there to be treated with the Contura applicator."
Deborah lives two-and-a-half hours from Des Moines, but she was fortunate to be able to stay with relatives while she underwent APBI for a week in October 2008. She received radiation at 8 a.m. and 2 p.m. each day, with each appointment lasting about an hour. Before each session, she underwent a CT scan to check the catheter's placement and spent six to eight minutes receiving radiation while relaxing and listening to music.
"It's hard to convince people who haven't had APBI just how non-invasive it is," Deborah says. "I felt great the whole time and never experienced any side effects. I was able to fit in a lot of shopping between sessions. At week's end, a bandage was placed over the insertion point, and Dr. Isaak told me to check in with my surgeon at home once a week. My family and I participated in a cancer walk in Des Moines three days after I finished treatment."
Looking Forward to the Life Ahead
Life for Deborah now has returned to its normal rhythm, which includes working at a physician's clinic in Storm Lake and decorating her home and yard with her husband, Mark. She has been in remission for more than 16 months, and a recent mammogram revealed no signs of recurrence. She is very thankful for the support she received from her husband, her son Brian, and the entire staff at John Stoddard Cancer Center.
"I can't say enough about Dr. Isaak and his staff at John Stoddard," Deborah says. "They guided me to a successful conclusion to my cancer journey. My strongest desire now is to let other women know that options like APBI exist. If I can help just one other woman, I'll be very happy."
For more information about radiation therapy at John Stoddard, visit our "Treatment Options" page.