CPT® Code 0395T

1. Indications

The high dose rate electronic brachytherapy procedure is indicated for the treatment of specific conditions, particularly in the context of breast cancer management. The following indications are explicitly recognized for this procedure:

• Breast Cancer Treatment This procedure is primarily utilized for the treatment of breast cancer, especially following a lumpectomy, to target residual cancerous cells in the breast tissue.

2. Procedure

The procedure for high dose rate electronic brachytherapy involves several critical steps to ensure effective treatment delivery. Each step is designed to maximize the precision and safety of the radiation therapy.

• Step 1: Applicator Insertion The first step involves the insertion of the brachytherapy applicator device into the body. This can be done interstitially, where the device is placed directly into the tissue, or intracavitarily, where it is inserted into a body cavity at the site of the malignant neoplasm or the tumor bed following lumpectomy. This precise placement is essential for targeting the radiation accurately.
• Step 2: Treatment Planning After the applicator is in place, the radiation oncologist verifies the target volume that needs to be treated and determines the prescribed dose of radiation. Any necessary adjustments to the treatment plan are made using computerized brachytherapy dosimetry, ensuring that the radiation is delivered effectively to the intended area.
• Step 3: Shielding Application To protect normal tissues from radiation exposure, a shielding device is applied. This may include external shielding as needed, which is crucial for minimizing the risk of damage to surrounding healthy tissues during the treatment.
• Step 4: Dose Delivery Setup The prescribed dose of radiation is set on the control panel of the X-ray generator. A check run of the X-ray generator is performed to ensure it is functioning correctly before the actual treatment begins.
• Step 5: Radiation Delivery Once the control panel is set, the X-ray generator is activated, and the high-dose electronic brachytherapy is delivered to the tumor or tumor bed for the prescribed duration, which typically ranges from 10 to 40 minutes. If a multichannel applicator is used, this process may be repeated as necessary to ensure comprehensive treatment.
• Step 6: Fractionation The treatment is divided into fractions, with a standard regimen following lumpectomy consisting of 10 fractions delivered over five days, with two fractions administered per day. Each fraction is reported separately, allowing for detailed tracking of the treatment progress.
• Step 7: Applicator Retention The brachytherapy applicator is left in place until the entire treatment course is complete, ensuring that the radiation can be delivered consistently and effectively throughout the treatment period.

3. Post-Procedure

Post-procedure care for patients undergoing high dose rate electronic brachytherapy typically involves monitoring for any immediate side effects or complications related to the treatment. Patients may experience localized discomfort or skin reactions at the treatment site, which should be managed according to standard post-radiation care protocols. Follow-up appointments are essential to assess the effectiveness of the treatment and to monitor for any potential recurrence of cancer. Additionally, patients may receive guidance on managing any side effects and recommendations for ongoing care as they recover from the procedure.