Running head: ELECTRONIC BRACHYTHERAPY

Electronic Brachytherapy as Adjuvant Therapy for Early Stage Breast Cancer: a Retrospective
Analysis
Heidi Grotenhuis
University of North Carolina at Charlotte

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Dooley, W. C., Wurzer, J. C., Megahy, M., Schreiber, G., Roy, T., Proulx, G., Laduzinsky, S., &
Lee, C. A. (2011). Electronic brachytherapy as adjuvant therapy for early stage breast
cancer: a retrospective analysis. Oncotargets and Therapy, 4, 13-20.
Key Observations
-I was surprised to learn that many women will elect to have surgical removal of their breast,
also known as a mastectomy, as opposed to undergoing radiation therapy. The article addressed
that the decision for this was based upon the time required in undergoing radiation therapy,
which can be up to six or seven weeks of daily treatment. I do not argue that this is not the case
for many, but I do find it interesting that it was not mentioned that some women might rather
lose a breast to ease their own fears of a reoccurrence from happening in the future.
-The article references several types of treatment options for radiation therapy in early stage
breast cancer patients. Electronic brachytherapy, also known as EBT, delivers an x-ray source via
surgical implantation of an inflated balloon into the surgical cavity where the breast cancer
previously resided. The goal is a more targeted form of therapy in the hope of reducing radiation
exposure to the healthy surrounding tissue. The more common form of this method is referred to
as iridium-192 brachytherapy, which uses radiation in the form of iridium-192 that is inserted
into the surgically implanted balloon. Another option for radiation treatment is the use of external
beam radiation therapy, also known as EBRT. This form of treatment however, is not as precise
as EBT or iridium-192 brachytherapy and exposes a patients healthier tissue outside the tumor
site to harmful radiation. This form of radiation has a significantly longer treatment time (six
seven weeks) in comparison to EBT or iridium-912 brachytherapy (only one week).
-EBT uses an x-ray source to treat the tissue surrounding the former tumor site and does not use
a radioactive isotope such as iridium-192 used in iridium-192 brachytherapy. This is
advantageous to both small and large radiation therapy centers. The use of iridium-192 needs a

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special vault created for the administration of the isotope that is very expensive to build. In
addition, EBT is portable and can move to room to room without having to be confined to a
specially created vault, which can increase the amount of patients treated on daily basis and can
provide scheduling flexibility.
Key Questions
-Has this study influenced hospitals and treatment centers to consider switching from the use of
iridium-192 brachytherapy to EBT? It appears advantageous on two important fronts. EBT does
not require the use of a specially created vault to deliver the x-ray source to the tumor site or the
special care and handling of a radioactive isotope. This reduces costs for institutions as well as
increases the amount of patients who can be treated. In addition to EBT being cost effective, it
has also been shown to expose patients to the same amount of toxicity as iridium-192
brachytherapy. However, the amount of EBT radiation exposure within patients was significantly
reduced in the healthy tissue and critical organs such as the heart and lungs.
-EBT and iridium-192 brachytherapy appear to be a more welcome alternative to external bean
radiation therapy (EBRT), which can last between six to seven weeks. EBRT also exposes a
greater portion of healthy breast tissue and nearby organs to radiation in comparison to EBT or
iridium-192 brachytherapy. What are the factors that lead some patients to experience a shorter
treatment course with less radiation exposure to healthy tissue and organs, as opposed to those
who are treated with EBRT?
-The article stated that patients who receive EBRT receive daily treatment for six to seven weeks.
It also stated that EBT and iridium-192 brachytherapy treat patients twice a day for five days.
This seems like a better alternative, but how long are these treatment sessions? Does it vary
patient to patient? Also, after the patients course of treatment is completed, does the surgically

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implanted balloon require another visit to the operating room to be removed or is it done in the
surgeons office? Does it require any type of protocol since it was exposed to radiation?