Radiation Therapy

/Home/h. Breast Cancer Diagnosis & Treatments/Breast Cancer Treatment - Radiation

Radiation Therapy

Radiation therapy (also known as radiotherapy) uses targeted, high-energy X-rays to kill cancer cells. For women with early stage breast cancer, radiation therapy is almost never used alone; it is almost always used with surgery. Its purpose is to kill cancer that might be left in the breast or surrounding area after surgery. This is very important with lumpectomy (also called breast conserving surgery), since so much of the breast tissue is left intact.

Most women who have a mastectomy do not need radiation therapy. However, in some cases, radiation is used after mastectomy to treat the chest wall and the lymph nodes in the armpit (axillary nodes).

Eligibility for Radiation Therapy
Radiation therapy after surgery is an option for women who have ductal carcinoma in situ, early stage breast cancer, locally advanced breast cancer or inflammatory breast cancer. However, not all women with these types of cancer are eligible for this treatment. Certain medical illnesses can make radiation therapy harmful.

Conditions that make a woman ineligible for radiation therapy are:

History of scleroderma or systemic lupus. These disorders can keep tissue from healing correctly after lumpectomy and radiation.
Pregnancy. The radiation can harm a fetus. If a woman is in her third trimester, she can have surgery and wait until after delivery to have radiation therapy.
Previous radiation therapy to the affected breast. In general, radiation therapy can only be given once to an area.
Women who have breast implants made of saline or silicone are eligible for radiation therapy. However, implants can make radiation therapy planning more complex. They may also shrink after radiation therapy, leading to a poor cosmetic result. If your treatment plan includes mastectomy, radiation therapy and breast reconstruction, it is important to discuss potential risks of the types of reconstruction with the breast surgeon and radiation oncologist. For more on breast reconstruction, click here.

Going Through Radiation Therapy
Planning Sessions
Radiation therapy can damage normal tissue, so it needs to be carefully planned and then precisely given. This helps ensure that the radiation kills as many cancer cells as possible while doing as little damage as possible to other parts of your body. Every woman must have her therapy planned specifically for her, since each woman's body is shaped differently. In general, therapy is planned based on tumor characteristics, such as size, type and location.

The radiation planning sessions are usually overseen by the radiation oncologist who will be giving the therapy. At these sessions, you will lie on a special X-ray table while the oncologist determines how high the dose of radiation should be and where it should be given. In some instances, the planning will be done using a CT scan.

During the planning, the radiation oncologist places small marks on your skin (about the size of a pinhead) to direct the radiation during the sessions. These can be ink spots, or they can be actual tattoos. If they are ink spots, it is important not to wash them off until after radiation therapy is completed.

Radiation Therapy Sessions
During a radiation therapy session, you will lie on a special X-ray table. Usually, the entire breast will be given a dose of radiation. If during surgery lymph nodes were found to have cancer, adjacent lymph node areas may also get radiation. (For more on lymph nodes, see the Diagnosis section.) Each session lasts only about minutes. Most of this time is spent correctly positioning your body. Treatment is usually given one session a day, five days a week, for five to six weeks.

At the end of the five or six weeks, you may receive an additional higher dose of radiation (boost) to the part of the breast that had the tumor. This helps get rid of any cancer left in the area of the original tumor. The boost can be given the same way the therapy was given in the regular sessions or as an implant. With this procedure, small, radioactive "seeds" or a single small balloon is implanted in the breast near the surgical site.

Things to Remember While Going Through Radiation Therapy
Do not wash the ink marks off your skin.
Do not put lotions or powders on the affected area when being treated.
Do not use deodorants or deodorant soaps.
Do not wear tight-fitting clothing or jewelry.
Use reliable birth control to prevent pregnancy, since radiation can harm a fetus.
Keep the treated area out of the sun.
Keep your health care provider informed about side effects.
(Adapted from the National Cancer Institute's Radiation therapy and you: support for people with cancer .)

Side Effects of Radiation Therapy

Radiation therapy can have a number of side effects. Some begin during treatment, while others might not happen for months or years afterward.

During and just after treatment, you may feel tired, and your treated breast may be sore. Mild pain relievers such as ibuprofen or acetaminophen can ease tenderness in the breast. The treated breast may also be rough to the touch, red (like a sunburn) and a little swollen. Sometimes the skin may peel a little, just like it would if it were sunburned. Your radiation oncologist may suggest creams to ease this skin irritation. Each of these symptoms usually begin within a few weeks of starting treatment and should go away a few weeks to a few months after treatment ends . In rare cases, however, pain may not develop until several months or years after treatment. For more on the management of pain related to treatment, click here.

During or just after radiation therapy, you may notice puckering around the scar and shrinkage of the breast. This is a temporary side effect for some women and a permanent one for others. Some women also experience slight, permanent tanning of the skin on the treated side. Nausea and hair loss are not usually associated with radiation therapy.

Women who have their axillary lymph nodes removed may develop lymphedema, a condition in which fluid collects in the arm, causing it to swell. The chances of getting lymphedema are greater if your treatment involves both the removal of multiple lymph nodes during surgery and radiation therapy of the regional nodes . For more information on lymphedema, click here.

Four rare conditions that may arise a few months to years following radiation treatment are rib fracture, heart injury, radiation pneumonitis and brachial plexopathy.

Rib fracture occurs when the radiation weakens the rib cage near the area of treatment.
Injury to the heart can result from radiation therapy given to the left side of the chest. With modern radiation therapy planning sessions, however, this is increasingly unlikely.
Radiation pneumonitis is an inflammation of the lungs that can occur when the lungs receive a dose of radiation during the treatment. The condition usually occurs within the first few months of treatment and generally causes shortness of breath, a dry cough and low-grade fever. Severe symptoms can usually be relieved by anti-inflammatory drugs. Radiation pneumonitis almost always goes away with time.
Brachial plexopathy can result from radiation damage to nerves in the upper chest. It may cause tingling, pain and weakness in the affected hand and arm. The damage can be permanent or temporary. The higher the dose of radiation to the axillary nodal area, the greater the chance the damage will be permanent.
Rarely, radiation treatment can cause a second cancer, such as leukemia, lung cancer, ovarian cancer or cancer to the contralateral (opposite) breast -. However, this risk is very small and is usually far outweighed by the benefits of radiation therapy.

Emerging Areas in Radiation Therapy

One of the main drawbacks of radiation therapy is the frequency and long duration of the radiation treatment. Therefore, one area of active study is the use of approaches that shorten the course of radiation therapy. These are being studied in clinical trials. The results of the trials will determine whether the therapies become part of standard care. After talking with a health care provider, it is important to consider participating in clinical trials of new radiation therapies for breast cancer.

Accelerated Whole-Breast Therapy
Accelerated whole-breast therapy uses the same general approach of standard radiation therapy except that it uses a slightly higher dose of radiation per session, which allows for a shortened course of therapy. Only a few studies have been done to date on the procedure, but these have had some encouraging results -. Evidence from a Canadian randomized trial found that women who received an accelerated three-week course of therapy did as well in terms of cancer recurrence as those who received a standard five-week course of treatment . These results, however, need to be duplicated by other, longer-term trials. In addition, it is unclear exactly how the findings from this Canadian study would apply to treatment in the United States. Although the countries are not vastly different from each other in their approach to treating breast cancer, there are still some differences in the timing and technique of radiation therapy.

Also unclear are the long-term side effects of increasing the dose per session. One very large study of radiation therapy suggested that higher doses per session may increase the risk of death by conditions like heart disease.

Accelerated Partial Breast Irradiation
Accelerated partial breast irradiation delivers radiation only to the area surrounding the tumor bed (the surrounding tissue and empty space left after the tumor has been removed during lumpectomy) and greatly reduces the number of radiation sessions needed. It can be performed by brachytherapy, conformal external beam or by intraoperative radiation therapy . Accelerated partial breast irradiation is being studied only among women with lymph node-negative, early breast cancer who meet specific criteria concerning age, tumor size and margin status.

Brachytherapy
Brachytherapy is a procedure that uses targeted radiation therapy from inside the tumor bed. Implantable radiation "seeds" (interstitial radiation therapy) or a single small Mammosite balloon device (intracavitary radiation therapy) can be used to deliver the radiation. The procedure has most often been used in addition to standard radiation therapy, providing a "boost" dose of radiation to kill remaining cancer cells.

Brachytherapy is also being studied as an alternative to standard radiation therapy. This could potentially eliminate the need to give radiation to the entire breast over a five- to six-week period, the current standard for radiation therapy. In brachytherapy, because radiation is limited to the area around the tumor bed, the course of treatment is only about a week long. Despite these potential benefits, brachytherapy is still being studied as a replacement for standard radiation therapy. Women should only consider this procedure as part of a clinical trial studying its effectiveness.

Conformal external beam radiation therapy
Conformal external beam radiation therapy uses an external beam of radiation to target the tumor bed. Similar to brachytherapy, a limited area of the breast receives radiation, and treatment can be completed in about one week. This therapy is not widely available at this time.

Intra-Operative Radiation Therapy
Intra-operative radiation therapy is similar to brachytherapy in that it involves targeted radiation to the tumor bed in higher doses than would normally be given during a standard radiation therapy session. The main difference is that with the intrao-perative procedure only a single dose of radiation is given during the lumpectomy operation, rather than a number of doses in the days following the operation. As with brachytherapy, intra-operative radiation therapy is an experimental procedure that needs to be studied further before its risks and benefits are known. Currently, it is being evaluated primarily in Europe.

© 2009 Susan G. Komen for the Cure®