Preparation for Treatment
The initial catheter placement for this treatment is performed at the Seattle Cancer Care Alliance. You will need to bring your medications with you to take as instructed by your nurse.
Transportation
Make sure you have arranged transportation home after your procedure. You will not be able to drive yourself because of the sedating effects of the medications. Your nurse will have more specific information on these medications during your radiation oncology visit.
Diet
You can eat a light breakfast or lunch one hour prior to arrival, but you may want to limit fluid intake until after the procedure.
What to wear
Loose fitting clothing that buttons down the front will make it easier to get dressed after your procedure.
Aspirin or anticoagulants
Do not take aspirin or anticoagulation medications prior to your procedure. Discuss this with your doctor.
Herbal supplements
Stop herbal supplements one to two weeks prior to procedure.
Thermometer
You will need an oral thermometer to check your temperature three times a day.
Placement of the Treatment Catheters
When your procedure starts, your breast will be numb from the Emla cream. First, an ultrasound will be performed to identify the lumpectomy cavity. Fluid will be drawn from the cavity with a syringe and a contrast dye will be injected. Tell the nurse or doctor if you have had any previous reactions to contrast dye. Constrast dye helps your doctor see the area of needle placement more accurately under mammography.
Next, you will be taken to the mammography room for placement of the brachytherapy catheters. Your breast will be scrubbed with an antibacterial solution to help prevent infection. Then you will be positioned face down on the table, with your affected breast lying through a hole in the table. The medication you took should help you feel relaxed and as comfortable as possible while in this position for the procedure. A plastic template is then applied to the breast. The template has many little holes that help your doctor to guide the needles in the correct location around the lumpectomy cavity. A mammogram is taken with the template in place to ensure that it is in the right location for placement of the catheters. Once the doctor is sure that the template is in the right location, a mixture of medications will be injected into the breast that will numb the skin and tissue before placement of the needles.
After the breast is thoroughly numb, the needles are placed. Another film is taken to be sure that the needles are all in the correct location. Then the plastic catheters are threaded through the needles and the needles are removed.
You will be assisted to a sitting position, and little plastic buttons will be applied to the ends of the catheters to secure them in place. Your nurse will apply antibiotic ointment to the skin at the catheter entrance and exit sites. This will help to prevent infection. A surgical bra and additional sterile dressings will help keep everything clean and the catheters in place.
Finally, you will be allowed to be driven home. You should take your pain medications as told. You will return the next day to the UW Medical Center Cancer Center for filming and a dressing change.
Daily Treatments
On the following Monday, your radiation treatments will begin. You will be treated twice a day, with about six hours between treatments. When you arrive, a receptionist will page your nurse who will escort you to the brachytherapy treatment room and help you to get comfortable on a stretcher. The nurse will remove your surgical bra and dressings and check your skin for any infection or irritation. Your doctor and a physicist will connect the numbered catheters to a flexible cable. Each cable will then be connected to the treatment machine. Your treatment will be delivered and monitored from outside the room.
During the treatment, a radioactive seed will slide inside each catheter and stay there for the proper amount of time. You will not feel the radiation treatment as it is given. You will hear a clicking sound from the treatment machine.
Your nurse will then apply new dressings and you will be allowed to leave the clinic until your next scheduled appointment. There will be no radiation left inside your body after the treatment. You should expect the entire process to take about one hour each time.
After Treatment
After your last treatment, the catheters are removed with very little discomfort. There is usually little or no bleeding. Your nurse will cleanse the breast and apply antibiotic ointment to the catheter entry and exit sites.
Your nurse will send you home with all the skin care supplies you will need to care for yourself after treatment. The nurse will review instructions for your care at home and when to call your nurse or doctor.
You will need to keep checking your temperature twice a day. Call us if your temperature exceeds 100.5 degrees F, or if you notice increased redness, tenderness, or cloudy drainage from any holes.
You will follow up one month after treatment. If you come from out of state, your local doctor can monitor you for the first six months. You should return to the UW Medical Center Cancer Center six months after brachytherapy for your first post-treatment mammogram and physical examination.