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Scottsdale, Arizona 85251


(480) 922-4600
 

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Scottsdale, Arizona 85258


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Phoenix, Arizona 85027


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Gilbert, Arizona 85297


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This page can be revisited at:
http://www.arizona-breast-cancer-specialists.com/treatment/multiple-catheter-technique.html

Multiple Catheter Technique


For some women, the prospect of having multiple thin plastic catheters in their breast can be intimidating. We hear comments like: "Wow ... that must hurt!" Take a look at what our patients tell us about their experiences.
Actually, the catheter insertion is performed under generous local anesthesia, combined with some oral medications to relax the patient and to provide additional pain relief. Our goal is to make this procedure painless and bloodless. We keep a list of treated patients who have agreed to be 'references.' Call them and ask about their experience! Breast brachytherapy catheter placements and the radiation treatments are described in detail on our site under Brachytherapy Treatment.
All patients will first have a consultation with one of our physicians. During this consult, we review all of information, perform a careful physical exam, and then counsel the patient carefully about all of her options, including external beam radiation therapy and brachytherapy.
If she chooses breast brachytherapy, we schedule our clinic operating room for the 1 to 2-hour procedure and make sure we have the patient's favorite music loaded into our stereo system! Remember, you are awake and joking with the physician throughout the procedure. Before the procedure, we offer patients a mild pain killer and a mild relaxing medication, both in pill form.
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.
Brachytherapy targeting
Illustration: The template is applied and a "targeting" CT san is done. The cavity is shaded above.
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.
Illustration: Using the CT information, the template holes to be used are indentified and marked.
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.
Anesthetic injected into brachytherapy catheters
Illustration: Local anesthetic is injected into the breast where catheters are to be placed.
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!
Multi-catheter brachytherapy technique.
Illustration: Multiple Catheter Technique. Step 1 - The target for the catheter implant is the tissue around the lumpectomy cavity.
Step 2 - An x-ray dye (contrast) is injected into the cavity under local anesthesia.
What to Expect
A typical evaluation and treatment sequence would be:
  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 our office 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 our physicians, but the SAVI®, Contura®, or MammoSite® can be placed by either your breast cancer surgeon or by one of our physicians.
  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 between 6 and 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, take 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.
MammoSite®, SAVI®, Contura®, and other present and future devices.
These balloon or egg-whisk shaped devices are single-entry devices and can be inserted by the surgeon or one of our physicians. 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.
We hope this information is helpful.
Please do not hesitate to call if you have questions!