Radiation Therapy for Breast Cancer

Overview

The approach to treating breast cancer typically includes radiation therapy employing high–energy X–rays to eradicate or damage cancer cells within the breast. 

Surgical procedures, usually conducted by breast surgeons or surgical oncologists, aim to excise tumors. Post–surgery, radiation oncologists oversee radiation therapy to specifically target and eradicate any remaining cancer cells. For individuals with metastatic breast cancer, this treatment may be utilized to alleviate symptoms related to breast cancer or symptoms arising from other affected areas of the body. 

Radiation therapy used in treating breast cancer may lead to both short–term and long–term side effects.

Types of radiation therapy for breast cancer

Radiation therapy for breast cancer can be administered through various methods selected by your radiation oncologist based on factors such as cancer location and type. The types of radiation therapy for breast cancer include:

• External Beam Radiation Therapy (EBRT): Utilizing a linear accelerator, this treatment directs high–energy radiation beams to the breast. Typically, this treatment is given five days a week for one to six weeks and may incorporate techniques like Intensity–Modulated Radiation Therapy (IMRT) or Stereotactic Body Radiation Therapy (SBRT).
• Brachytherapy: Internal radiation therapy involves placing a small radioactive seed into the tumor site using a catheter. The seed emits radiation for several minutes before removal. This treatment involves two sessions daily for five days.
• Intraoperative Radiation Therapy (IORT): A high dose of radiation is delivered to the tumor area in the exposed breast tissue during this procedure. Conducted in the operating room, IORT occurs after tumor removal and before surgical site closure.

Risks

Radiation therapy typically doesn’t induce immediate side effects, but both short–term and long–term reactions may occur.

Short–term side effects may include:

• Fatigue: Mild fatigue is common during treatment, resolving a few weeks after its completion.
• Breast pain: Dull or sharp shooting pains in the breast, with intermittent occurrence. Soreness of the nipples or breast may be present.
• Alterations in skin tone: Fair–skinned individuals may exhibit a sunburn–like appearance, while dark–skinned individuals may notice a darkening of the skin.
• Skin irritation: Dryness, flakiness, and peeling may occur, and some individuals may experience moist desquamation, particularly in skin folds under the breast or between the breast and arm. Blistering and peeling of the skin may occur.

Long–term side effects may include:

• Spider veins (telangiectasias): Considered normal and not a cause for concern.
• Alteration in breast size: Your breast may increase or decrease in size.
• Persistent fatigue: Prolonged feelings of tiredness lasting for weeks or months post–treatment.
• Lymphedema: Swelling affecting the arm on the side of the breast cancer, observed in some cases where radiation therapy involves lymph node areas.

Unlike certain chemotherapy treatments, most individuals do not experience hair loss on the head during radiation therapy, although armpit hair loss may occur.

Complications from radiation therapy for breast cancer are rare but may include chest–related issues. Possible complications encompass:

• Radiation heart disease (cardiotoxicity), involving atherosclerosis, arrhythmias, and heart valve disease.
• Brachial plexopathy, nerve damage affecting shoulders and arms.
• Development of new cancers within the lining of blood and lymph vessels (angiosarcoma).
• Pulmonary fibrosis.
• Fractured ribs.

Before the procedure

Your initial appointment serves as a planning session, providing an opportunity for your radiation oncology team to clarify procedures and address any inquiries. During this session, the team will:

• Outline your treatment schedule, including the frequency of radiation sessions and what to anticipate during treatment. Typically lasting 30 to 45 minutes, radiation therapy is administered in two–to–three–minute increments within a 15–minute timeframe.
• Explain the delivery process, the positioning of the team during treatment, and any restrictions, such as movement during the procedure.
• Demonstrate protective techniques for your heart and lungs, such as deep inspiratory breath holds, which involve holding a deep breath at specific intervals to safeguard these organs during treatment.
• Recommend pre–treatment measures for your comfort, such as wearing loose–fitting clothing that avoids contact with the treated breast skin.
• Discuss potential side effects and strategies for managing them, including the option of palliative care for symptom and side–effect relief.

Understanding what lies ahead allows you to effectively organize and manage your personal agenda, including work and other engagements, around your treatment schedule.

The planning session incorporates a simulation, where your radiation oncology team employs a Computed Tomography (CT) scan to delineate the treatment area on your breast. The simulation may last an hour or more, and during this process, the doctor will:

• Position your body in an immobilization device on the treatment table, ensuring the correct alignment for all sessions.
• Instruct you on techniques to shield your heart and lungs from radiation exposure.
• Use a tattoo device to mark the treated area’s corners on your breast. These marks, approximately the size of a freckle, aid in aligning the radiation treatment consistently. The marks can be either permanent or temporary, depending on your preference, which you can discuss with your radiation oncologist.

During the procedure

Upon your arrival for treatment, you will be provided with a medical gown to wear during the session. The subsequent steps include:

• Guiding you to the treatment room.
• Assisting you onto the treatment table, where most individuals lie on their backs, though sometimes lying on the stomach may be necessary based on the treatment plan. If applicable, you’ll place an arm above your head (on the side of the breast with cancer).
• Aiding you in getting into position within the immobilization device. For those receiving radiation therapy post–mastectomy, a flat wet towel or rubber piece may be placed on the treated part of the breast to enhance radiation exposure to the skin.
• Aligning the linear accelerator with the initial treatment area, as explained by your team. They will leave the room during treatment but maintain visibility and audibility.
• Activating the machine, which produces a whirring noise. The radiation beams are invisible, and you won’t experience any sensation.

Once the treatment concludes, your team will assist you in getting up from the treatment table.

After the procedure

Radiation therapy can induce tenderness, itching, and pain in your skin, affecting your appetite and causing fatigue. Consider these tips to navigate through treatment:

• Opt for loose–fitting cotton attire to prevent rubbing and discomfort.
• Treat your tender skin with care, using mild soap and warm water. Seek recommendations from your radiation therapy team for creams or lotions that alleviate side effects without harming your skin.
• Prioritize rest, especially during the final treatment sessions when fatigue may be more pronounced. Schedule periods of relaxation into your daily routine.
• Maintain a well–balanced diet comprising healthy grains, fruits, vegetables, lean protein, and low–fat dairy to support your strength during treatment.
• Incorporate regular, gentle exercise, such as a 30–minute daily walk, to help manage fatigue.

Outcome

After completing radiation therapy, your healthcare team will schedule follow–up appointments to monitor progress, detect any late side effects, and watch for signs of cancer recurrence. Upon completion of your radiation therapy, inform your doctor if you encounter:

• Any other troubling symptoms
• New occurrences of lumps, bruises, rashes, or swelling
• Unexplained weight loss
• Persistent pain
• A persistent fever or cough