Multiple Catheter Technique

During the procedure, the patient lays on her back with a pillow under her knees for comfort. The template is positioned carefully around the breast and moderate compression applied with the 2 thin Plexiglas templates.

As you can see in this actual case, the cavity is seen as deep purple, the skin is colored blue, and the target tissue is pink 2 cm around the cavity.

The holes that cover the target volume are clearly seen and marked with a red X on the form at the top. Meticulous coverage to the millimeter of the target tissue is achieved every time!

Local anesthetic is injected with a very thin needle through the selected holes in the template, which encompass the location of the lumpectomy cavity plus 2 cm (about 3/4 inch) all around.

This local anesthetic is mixed with sodium bicarbonate, so there is none of the usual initial burning pain before it goes numb. This local anesthetic also contains small amounts of epinephrine, which stops bleeding from small blood vessels; there is very little bleeding from this procedure. Most patients have NO pain and NO bleeding with catheter insertion that follows the anesthetic injection. Patients are awake, talking with us during the procedure and listening to Mozart, Billy Joel, New Age, rock, or their favorite music the whole time (please - no hip-hop or rap!). Most are surprised when it is all over. The local anesthetic wears off in 6 hours and for any soreness or pain that persists, we provide pain medications and mild sleep aids. After one day, however, many patients do not require anything more than Tylenol for the pain.

The following day (sometimes this is done the same day) the patient returns to our clinic for a radiation planning and dose-calculation CT scan. This visit will last about 60 - 90 minutes and the patient does not need to take any contrast 'dye' by mouth or in her veins, as many regular diagnostic CT scans require. After this planning CT scan, she can return home. Using the information from this planning CT scan, our physicists carefully program the radiation treatment machine to deliver a customized treatment. The treatments start the next day (two days after the catheter placement procedure). We treat patients Mondays-Fridays, but treatment can start on any day of the week. Patients receive ten treatments over five consecutive clinic days (treatments are given twice daily with six hour intervals between treatments). Each visit takes less than an hour. After the last treatment, the catheters are removed easily and painlessly.

The beauty of this technique is that it delivers radiation to the 2 cm (approximately 3/4 inch) of breast tissue surrounding the surgical cavity edge, with elegant precision. It's worth noting that this 2 cm coverage breadth is more than the treatment distance of the commercially available 'single-entry' devices mentioned above. Furthermore, unlike these devices, this interstitial technique can treat unusual cavity shapes and volumes. The physicians in our practice have more experience with this valuable interstitial multiple-catheter technique than any center in the world! Practice makes perfect!

1. Review of pathology, mammography, ultrasound, and MRI results by the radiation oncologist to determine suitability and feasibility of breast brachytherapy.
2. Consultation with physical exam by the radiation oncologist
3. Ultrasound and/or CT in the Radiation Oncology Department to evaluate the surgical cavity size and shape. This step confirms that the size and shape of the surgical cavity is appropriate for this procedure.
4. Discussion with the radiation oncologist regarding possible techniques: interstitial multiple-catheter technique vs SAVI® vs Contura® vs MammoSite®
5. The catheter(s) placement procedure is performed. The interstitial technique is done by one of us, but the SAVI®, Contura®, or MammoSite® can be placed by either your breast cancer surgeon or by one of us.
6. The radiation planning CT is done the day of, or the day after, the catheter insertion. This is a special type of CT scan done in our clinic.
7. Our Physicists require one full day to plan and create the perfect treatment. Treatment begins usually 2 working business days after catheter insertion, often on a Monday.
8. Treatments usually last ~ 6-15 minutes each, and the patient is in the clinic for about 40 minutes each time, including nursing time to clean and dress the catheter entry sites. Treatments are generally 6 hours apart. Treatments typically (but not always!) are 5 business days (Monday through Friday)
9. Overall duration with catheters in place: usually 8-9 days
10. After the last treatment we remove the catheter(s) and you go home! We see you one week later to check the healing of your breast, and again one month later.
11. The first follow-up mammogram is 6 months after treatment: sign out your films and bring them in to the radiation oncologist for a "second over-reading" of your films with the physician explaining what we look for on the breast images. We integrate your future follow-up visits with the surgeon and medical oncologist; we believe your radiation oncologist is a vital part of your follow-up evaluation and strive to participate in your follow-up long term.

These balloon or egg-whisk shaped devices are single-entry devices and can be inserted by the surgeon or one of us. The beauty of these devices is in their simplicity. The size and shape of the surgical cavity is critically important to whether these devices can be used. The separation of the cavity from the skin is also a key factor. For example, if the MammoSite balloon is less than 7 mm from the skin surface, we will usually pull it and go to another technique. These devices treat 1 cm of tissue beyond the cavity edge (a little more than 1/3 of an inch), rather than the 2 cm of the multicatheter technique, so we select women with favorable breast cancers for the single entry devices. We have reviewed each device in the next section on our website.