The MammoSite breast brachytherapy applicator: a review of technique and outcomes

The MammoSite breast brachytherapy device was designed to overcome the potential scheduling problems associated with external beam radiotherapy (EBRT) and the technical difficulties of multi-catheter-based interstitial brachytherapy. The device consists of a silicone balloon connected to a catheter which contains an inflation channel and a port for passage of a high-dose-rate brachytherapy source. The American Brachytherapy Society and American Society of Breast Surgeons have published partial breast irradiation (PBI) patient selection guidelines. The MammoSite applicator has been shown in two dosimetric studies to treat a comparable volume to multicatheter-based interstitial implants. The MammoSite catheter can be placed at the time of lumpectomy or in a separate procedure using ultrasound guidance. Four optimization methods have been described: the single point method, the six prescription point method (RUSH Technique), the University of Southern California Norris Cancer Center Method, and the Surface Optimization Technique. An excellent or good cosmetic outcome has been reported in 80% to 93% of patients at 1 year in most studies. Cosmetic results appear highly related to skin spacing. The MammoSite applicator has been associated with early side effects comparable with traditional breast conserving therapy. A NSABP trial will randomize patients to either whole breast irradiation or PBI consisting of interstitial brachytherapy, MammoSite brachytherapy, or 3D conformal radiation.