Jane Brandhagen: It was a shock, you know. I was already in my mind picking out wigs and thinking how much longer I'd have here. I was terrified.
Dennis Stoda: Jane Brandhagen was facing the news one in eight women will hear-- she had breast cancer. Her yearly mammogram had revealed a small tumor. She wanted to treat it very aggressively and wanted to wrap up her treatments as quickly as possible.
Jane Brandhagen: I could have gone with a full-out double mastectomy, and then I would be done.
Dennis Stoda: Mayo Clinic surgeon Dr. Tina Hieken says it's the main decision breast cancer patients have to make, to remove the entire breast in a mastectomy or have breast preserving surgery. Because Jane's cancer was caught early, Dr. Hieken says she was a good candidate for a new option which would also reduce her entire treatment to just a matter of days.
Tina J. Hieken, M.D., Breast/Melanoma Surgery, Mayo Clinic: So for those patients who have no evidence of disease in the lymph node and have small tumors that are completely removed with a lumpectomy, they leave the operating room with a catheter in place. It's an outpatient procedure.
Sean Park, M.D., Ph.D., Radiation Oncology, Mayo Clinic: So this is a breast model with the brachytherapy catheter device inserted into the lumpectomy cavity.
Dennis Stoda: Called brachytherapy, the catheter delivers the necessary follow-up radiation treatments internally in a fraction of the time of standard external radiation therapy.
Dr. Park: Treatments are done over five week days, twice a day, approximately six hours apart for a total of 10 treatments.
Dennis Stoda: Brachytherapy itself is not new, but patients routinely have to wait two to four weeks for a second surgery to implant the catheter, because that can't happen until a pathology report comes back saying it's OK to proceed. So Dr. Park and Dr. Hieken designed a treatment regimen to eliminate the waiting time by using a single surgery. First, special dyes are injected to identify any cancer cells that may have spread beyond the tumor site or to the lymph nodes under the arm. That allows a pathologist to immediately screen the lymph nodes and a safe margin of tissue removed from around the tumor while the patient is still under anesthesia. Once the all-clear is given, the surgery continues with a second incision to insert the brachytherapy catheter and expand it, filling the lumpectomy cavity. The very next day, the patient's radiation plan is mapped out during a simulation. The following morning, the brachytherapy begins using a computer-controlled robotic machine which manipulates a single radioactive seed smaller than a grain of rice within the implanted catheter.
Dr. Park: The radioactive seed will travel through the cable into the patient, into the catheter, and stop at different locations that we program it to for a different amount of time, and that shapes the radiation dose.
Dennis Stoda: Unlike externally-delivered radiation, Dr. Park says brachytherapy is delivered more precisely to the target area without passing through healthy tissue.
Dr. Park: Meaning the breast tissue, the chest wall, lung tissue, for left-sided cancer patients, importantly, the heart tissue.
Dennis Stoda: It's hoped the expedited brachytherapy option encourages more women to receive the full benefit of their recommended post-surgery radiation, particularly those living far from a treatment center.
Dr. Hieken: So with standard therapy, they're driving a couple hundred miles round trip each day for three, four, or six weeks. The actual rate of completing the radiation may be as low as 60% or 70%.
Dennis Stoda: Jane says she leaped at the chance to be part of a pilot study that completed her brachytherapy in just three sessions.
Jane Brandhagen: So from Monday to Friday, five days, that was surgery and radiation all in five days, which I think is amazing.
Dennis Stoda: Jane and other patients in the study will continue to be followed for five years to verify that their long-term health and survival is just as good as those receiving standard radiation procedures. For the Mayo Clinic News Network, I'm Dennis Stoda.