About Breast Cancer

Our Unique 5 Day Option

We Are The 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 trial directly comparing 5-days of PBI with 6 weeks of conventional WBI. This trial will probably complete near the end of 2012.

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 committed 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!
Dr. Coral Quiet
Dr. Scott Tannehill
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.

Dr. Greg Maggass

We Are The Most Experienced Practitioners of Breast Brachytherapy In The World

Between the six radiation oncology physicians, Dr. Robert Kuske, Dr. Coral Quiet, Dr. Scott Tannehill, Dr. Gregory Maggass, Dr. Farley Yang, and Dr. Luci Chen, more than 1600 women have been treated with PBI over the last 18 years. No other practice in the world comes close to this record. As noted above, we have entered more patients onto clinical trials than the top academic institutions in the USA. Patients are sent to us for advanced breast brachytherapy from many of these institutions when simpler techniques will not suffice for their patients.

We expect 1/3 of our patients to come from out-of state or out-of-country because of the special expertise and experience that ABCs offers. In many cities, their leading hospital may have performed 5 or 10 PBI procedures, with doctors who may or may not have been to our lectures or courses in this technique. For a $250 airfare, why not be treated by the teacher rather than the student? Like surgery, with APBI, experience and skill matters! Remember, you must live with the radiation dose you have received for the rest of your life!!

We Teach Others Breast Brachytherapy

Our doctors teach PBI all over the world. If we did not have a passion for actually treating women with breast cancer, we could literally be gone most of the year giving lectures and workshops. Institutions in the US and abroad are asking us to “jump start our PBI program.”
Illustration: Dr. Kuske (in blue) is performing treatment with doctors observing.

To handle this demand, we are asking doctors to come to Arizona with their nurses, therapists, dosimetrists, and physicists. The entire team, one institution at a time, comes for a 2.5 day “crash course” in PBI, during which they will observe 2 or 3 live cases (with the patient’s permission!), lectures, and workshops.

You might ask: What if I need traditional whole breast or post-mastectomy chest wall and nodal irradiation? Answer: You are better off with us than a general radiation oncologist who also treats lung, prostate, rectal, and other cancers. There is an advantage to going to a physician totally focused on one disease! Do you go to a general surgeon or breast surgeon? Do you go to a general radiation oncologist or a breast radiation oncologist? With external beam techniques, the volume of lung, heart, and other normal tissues exposed to radiation varies tremendously from one radiation oncologist to the next. Dr. Kuske has published the The Kuske 5-field Technique of Comprehensive chest Wall and Nodal Irradiation that teaches how to wrap dose around the lungs and heart and minimizing collateral damage to internal organs. His educational videotape about this technique has been distributed around the world. Text-book chapters are devoted to it.

Our doctors will continue to lecture at national and international meetings. We have been asked to direct the international breast course in 2010 (www.tbc.com). We plan to bring this course to Scottsdale, Arizona, after previous annual meetings in Nice, France, Quebec City, Canada, and Key Largo, USA. We run the interstitial breast brachytherapy workshop at the annual meeting of the American Brachytherapy Society.

Illustration: Dr. Kuske (in blue) is being asked questions by participating physician.
We are writing book chapters and articles for the medical literature. We will post these as they are accepted for publication. Recently, the new textbook in APBI is being printed, and the chapter on interstitial brachytherapy and the history of breast brachytherapy was written by one of our doctors. An upcoming article on SAVI brachytherapy has been submitted and we expect that it will be the “go to” medical information on this new breast brachytherapy device.

Recently, the American College of Surgeons and the USC Norris Cancer Center convened a “think tank” of the 17 leading minds in breast cancer treatment today. One of our physicians had the great honor of participating, and was on the writing committee. The final document, “State of the Art Diagnosis and Treatment of Image-Detected Breast Cancer,” has rapidly been accepted for publication in a peer-reviewed journal.

As you can see from our track record, there is no better place to receive breast cancer treatment than ABCs. When you see our tag-line: We are writing the book on breast cancer care! – you now know that this is not a slogan, but a passionate commitment on the part of the only breast cancer focused radiation practice in the world.
Illustration: Nurses, therapists, dosimetrists, and physicists are all participating as well.

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