"Now we are achieving the same goals in radiation therapy by drastically decreasing the treatment for a very select group of patients," Gabram said. Gabram and her colleagues are studying a new method of radiation therapy - radiation from inside the breast instead of from the outside - that takes only five days versus six and one-half weeks for the traditional radiation treatment. If it proves effective, the new approach could make a huge difference for the comfort and convenience of women undergoing breast cancer treatment.

Libby Bula, 66, of Chicago was one of the first women to receive this leading-edge treatment at Loyola University Health System. Last spring, a lump was detected as a result of her routine mammogram. Subsequently, a needle biopsy showed that the lump was cancer. To learn about her options, Bula attended the Friday afternoon clinic of Loyola's Breast Care Center in the Cardinal Bernardin Cancer Center. The clinic is sometimes called a "one-stop shop," because of the collaboration of Loyola specialists. The patient's case is reviewed by surgical, medical and radiation oncologists as well as radiologists, pathologists and research nurses who discuss the intricacies of the case and treatment options from the perspective of each specialist's expertise and make a recommendation to the patient that same day.

"It is an intense, interactive discussion session that results in one consensus opinion of the best treatment option for each patient," said Gabram.

During the conference, Bula was identified as a potential candidate for the radiation therapy study. Women who qualify for the clinical trial are over age 50 and have very small tumors that have not spread to surrounding tissue or to lymph nodes. The type of cancer and position  in the breast also must meet certain criteria.

"A clinical trial is the best place to test the value of any new, innovative treatment or technology and learn more about it," said Kathy Albain, M.D., director of the breast cancer research program at the Cardinal Bernardin Cancer Center.

A week and a half later, Bula was in the operating room. Gabram removed the tumor in Bula's breast, including a small margin of tissue around the tumor. She identified and removed the sentinel node, which is the lymph node (or nodes) that drain fluid from the tumor site. Finally, she placed a small balloon at the site where the tumor was removed. When Gabram closed the breast incision, a catheter (small tube) from the balloon extended to the outside of the breast. Through this tube, the radiation treatment would be delivered.

In the operating room, an initial evaluation of the tumor's tissue margins and lymph node showed that Bula's cancer had not spread. The complete pathology report, delivered a few days later, confirmed the good news: The cancer had not spread beyond the small tumor, so Bula would be a good candidate for the clinical trial.

Internal radiation therapy, in which the radiation source is placed inside the body, is called brachytherapy. The concept is not new, noted Kevin Albuquerque, M.D., the radiation oncologist who treated Bula and the principal investigator for the brachytherapy study at LUHS. Different methods of brachytherapy are used to treat cervical cancer, endometrial cancer, head and neck tumors and other disorders. In fact, a form of brachytherapy has been used to treat breast cancer patients for more than 10 years, but the delivery method (which involves multiple needles through the breast and requires hospital admission) is not as easily performed as the new balloon catheter approach.

Brachytherapy offers several benefits over traditional external radiation therapy. The radiation is targeted to the site where cancer is most likely to recur. Fewer sessions are needed, because a larger dose of radiation is delivered to the target area. The treatment causes fewer side effects, because very little radiation reaches healthy tissues.

A week after Bula's surgery, Albuquerque ordered a CT scan to see if the balloon inside her breast was well fitted to the tumor site. After that, he treated Bula twice a day for five days with brachytherapy. A small radioactive pellet is inserted into the catheter and sits in the balloon for only a few minutes before being removed. The entire process takes about a half hour. Bula went home to rest between treatments.

About 1,000 patients nationwide have undergone this new treatment, which may eventually improve the breast conservation rate among women in the United States. Some women still receive mastectomies because, for various reasons, they are unable to undergo the long course of radiation therapy now required after lumpectomy, Albuquerque explained.

"It was nerve racking, but now that it's over, I feel pretty good about it," Bula said. "The doctors are wonderful people. I felt that I was in capable hands." Bula especially appreciated the care of Linda Millbrandt, the research nurse, who was by her side throughout her treatments. "She's a wonderful person," Bula said. "She cared. She walked me from place to place and always told me what was going on. It was comforting."  

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