Pioneers of Breast Brachytherapy

In 1991, no one was considering

partial breast irradiation (PBI)

. In England, there had been two miserable attempts at PBI with poor tumor control rates. Undaunted, Dr. Robert Kuske, chairman of radiation oncology, at the time of the famed Ochsner Clinic, pursued a phase II clinical trial investigating PBI as a 4-5 day alternative to conventional 6 weeks of external beam whole breast irradiation (WBI). He noted that the women in the British trials were poorly selected, inadequately treated, with non-existent quality assurance. Many of the women on these British trials were not even candidates for breast conservation therapy itself and should have been offered mastectomy!

Critics likened Dr. Kuske's PBI research to a salmon swimming upstream to spawn. Over the last 18 years, the journey has been long and arduous past dams (obstructions in the progression of clinical research), past Grizzly bears (hungry opponents trying to devour the entire project), and potential wrong turns up blind streams. But the reward at the end has been the spawning of countless individual studies, methods, and the birth of a potential paradigm shift in the very way that breast cancer should be treated.

Over the last two decades, PBI research represents the ideal of how medical research should progress. A single patient presented a challenge to two physicians, who sought to solve her particular problems and cure her cancer while taking quality of life, her family, her work, and her life preferences into consideration (read about Rosario's story by clicking here.) With brachytherapy, this patient could be successfully treated in four days instead of 6 weeks, and she was quickly back home with her family and returning to work. This single patient inspired the original New Orleans brachytherapy trial, and institutional review-board approved study. Two years later, doctors in Royal Oak Michigan started their own trial, validating the New Orleans favorable outcomes. Four years later, Dr. Kuske proposed a national phase II clinical trial to be sponsored by the National Cancer Institute. Six years later in 1997, the trial opened and became the most successful and rapidly accruing breast cancer trial in the history of the Radiation Therapy Oncology Group. The positive results of this trial (with now antiquated brachytherapy techniques!) were published in the international radiation oncology journal in 2008. Eleven years later in 2002, Drs. Kuske, Vicini, Arthur, White, and others proposed a historic randomized phase III clinical directly comparing 5-days of PBI with 6 weeks of conventional WBI. This trial will probably complete near the end of 2010.

Throughout this PBI history, Dr. Kuske has been the unquestioned voice and leader in this research. He has advanced the techniques and technology, and championed the research bringing us to where we are today. He has remained totally commited to his patients, who let him know in no uncertain terms that they wanted a shorter more convenient alternative with less radiation exposure to surrounding normal tissues.

Coral Quiet, MD, has been on the forefront of breast cancer care in the Phoenix region for 16 years. Her background is impressive, having worked as faculty at the University of Chicago under the leadership of perhaps the most prestigious name in breast cancer radiotherapy: Samuel Hellman, MD. In 1999, Dr. Quiet traveled to New Orleans for the annual meeting of the American Society of Breast Disease. She had followed PBI research, impressed by the 5-year data (at that time), and wanted to learn more about it. She studied with Dr. Kuske and they fast became friends and colleagues. She vowed to bring this 5-day alternative to the women of Arizona. She initiated a review-board approved clinical trial and began offering PBI to the women of the Valley. When the MammoSite balloon brachytherapy catheter was FDA-approved in 2002, she became the leading teacher of how to successfully perform this technique. As popularity of MammoSite blossomed, Dr. Quiet became more and more in demand as a teacher of other practicing physicians, and at the same time Phoenix-area women were choosing her to their physician for PBI. With her success in building a powerful program, she was able to recruit Dr. Kuske away from his Professorship in Human Oncology at the University of Wisconsin to help her expand the Arizona PBI program. Together, they have entered more than twice as many patients onto the national phase III clinical trial than any other institution in North America. That is more randomized clinical research in breast cancer than Harvard, MD Anderson, Stanford, and Memorial Sloan Kettering combined!

Scott Tannehill, MD, has an impressive academic record in radiation oncology. Upon completing his training at the University of Wisconsin, he joined the faculty at the University of Florida where he worked with the best head and neck cancer experts in the world. He was recruited back to the University of Wisconsin and assumed the leadership position for the UW program in high dose rate (HDR) brachytherapy for gynecologic malignancies. The data from this HDR treatment is referred to all over the world. Dr. Tannehill and Dr. Kuske worked side-by-side in the UW clinic, sharing ideas and dreams about building a gold-standard radiation practice someday. When Dr. Kuske left for the sunnier climate of Arizona, Dr. Tannehill took over the strong breast brachytherapy program at UW. He is now an acknowledged expert in accelerated partial breast irradiation. He arrived in Arizona with a faculty position at the University of Arizona in Tucson after a one-year sabbatical as staff radiation oncologist at the famed Peter MacCallum Hospital in Australia. He joined Arizona Breast Cancer Specialists (ABCs) and Arizona Radiation Oncology Specialists (AROs) in July, 2009. We are proud to have him join us since he is truly one of the best of the best in our field.

Gregory Maggass, MD, is the fourth physician in ABCs and AROs. He has practiced in the East Valley for more than 20 years.

Dr. Maggass is an established leader and pioneer in prostate brachytherapy and has treated thousands of men over the years in Arizona. He has learned PBI techniques from Drs. Kuske and Quiet, and brings special expertise to the Gilbert, Mesa, Chandler, and East Valley region. With his reputation, experience, and vision, Dr. Maggass will help ABCs expand our ability to offer all PBI options to a large number of women in the Valley.

With four outstanding physicians who wish to advance breast cancer care for Valley women, Arizona should continue to be the world-wide pioneers in this rapidly changing field of medicine.