How Is Radiation Given for Breast Cancer?

Radiation therapy for breast cancer utilizes high-energy rays or particles to destroy cancer cells that may remain after surgery, preventing recurrence and improving survival rates. The specific method of delivery depends on the individual’s cancer stage, surgical approach, and overall health, with the goal of targeting the affected area while minimizing damage to surrounding healthy tissue.

Understanding Radiation Therapy for Breast Cancer

Radiation therapy is a cornerstone of breast cancer treatment, often employed after surgery (lumpectomy or mastectomy) to eliminate microscopic cancer cells that may have been left behind. It can also be used before surgery to shrink tumors or as palliative treatment to alleviate symptoms in advanced stages. The aim is to precisely target the cancerous area with high doses of radiation, effectively destroying cancer cells while minimizing exposure to surrounding healthy tissues.

Types of Radiation Therapy for Breast Cancer

Several radiation therapy techniques are available, each with its own advantages and suitability depending on the individual patient’s circumstances:

External Beam Radiation Therapy (EBRT)

External Beam Radiation Therapy (EBRT) is the most common type of radiation used for breast cancer. A machine outside the body directs beams of radiation towards the breast or chest wall, targeting the area at risk. This method is typically delivered in daily fractions (small doses) over several weeks.

• 3D Conformal Radiation Therapy (3D-CRT): This technique uses computer imaging to create a three-dimensional picture of the breast and surrounding structures. This allows the radiation beam to be shaped to conform to the tumor’s size and shape, reducing exposure to healthy tissues.

• Intensity-Modulated Radiation Therapy (IMRT): IMRT is a more advanced form of 3D-CRT. It uses sophisticated computer software to further refine the radiation beam, delivering different intensities of radiation to different parts of the breast or chest wall. This allows for even more precise targeting of the cancer and further sparing of healthy tissues.

• Volumetric Modulated Arc Therapy (VMAT): VMAT is a type of IMRT where the radiation is delivered as the machine rotates around the patient. This allows for faster treatment times and can improve dose distribution.

Internal Radiation Therapy (Brachytherapy)

Brachytherapy, also known as internal radiation therapy, involves placing radioactive sources directly inside the breast or chest wall. This allows for a high dose of radiation to be delivered directly to the tumor bed, while sparing surrounding healthy tissues.

• Interstitial Brachytherapy: In this method, thin catheters are inserted into the breast tissue near the tumor bed. Radioactive seeds or a radioactive liquid are then inserted into the catheters for a short period of time. The radioactive sources are then removed, and the catheters are taken out.

• Intracavitary Brachytherapy (APBI – Accelerated Partial Breast Irradiation): This technique involves placing a balloon or other device into the cavity left after a lumpectomy. A radioactive source is then inserted into the device for a short period of time, delivering radiation to the tissue surrounding the cavity. This allows for a shorter course of radiation therapy, typically five days.

Proton Therapy

Proton therapy uses protons, rather than X-rays, to deliver radiation. Protons deposit most of their energy at a specific depth, allowing for more precise targeting of the cancer and potentially reducing side effects compared to traditional EBRT. However, it’s not as widely available and is usually reserved for specific cases.

The Radiation Therapy Process

The radiation therapy process typically involves several steps:

1. Consultation and Planning: A radiation oncologist will evaluate the patient’s medical history, perform a physical exam, and review imaging studies. They will then discuss the treatment options and develop a personalized treatment plan.

2. Simulation: During simulation, the patient is positioned on a treatment table, and imaging scans (such as CT or MRI) are taken to map out the treatment area. The radiation oncologist will then use this information to design the radiation plan.

3. Treatment Delivery: Radiation therapy is typically delivered five days a week for several weeks. Each treatment session is usually painless and takes only a few minutes.

4. Follow-up: After completing radiation therapy, patients will have regular follow-up appointments with their radiation oncologist to monitor their progress and manage any side effects.

Potential Side Effects of Radiation Therapy

While radiation therapy is effective in treating breast cancer, it can also cause side effects. The severity of side effects varies depending on the type of radiation, the dose, and the individual patient. Common side effects include:

• Skin changes: Redness, dryness, itching, or blistering of the skin in the treated area.
• Fatigue: Feeling tired or weak.
• Swelling: Swelling of the breast or arm.
• Pain: Pain or tenderness in the breast or chest wall.
• Lymphedema: Swelling in the arm or hand due to a buildup of fluid in the lymphatic system.
• Heart and Lung Problems: In rare cases, radiation therapy can damage the heart or lungs.

Frequently Asked Questions (FAQs) About Radiation Therapy for Breast Cancer

Q1: What are the goals of radiation therapy for breast cancer?

The primary goals of radiation therapy are to eradicate any remaining cancer cells after surgery, reduce the risk of local recurrence, and, in some cases, alleviate symptoms associated with advanced disease. Ultimately, the aim is to improve long-term survival rates.

Q2: How long does a typical course of radiation therapy last?

The duration of radiation therapy varies depending on the type of radiation and the extent of the cancer. EBRT typically lasts 3-6 weeks, while brachytherapy can be completed in a few days. Your radiation oncologist will determine the best schedule for your specific situation.

Q3: Will I lose my hair during radiation therapy for breast cancer?

Hair loss is unlikely if the radiation field is limited to the breast or chest wall. However, hair loss may occur if the radiation field includes the underarm (axilla), where lymph nodes are located.

Q4: Can I continue working during radiation therapy?

Many patients can continue working during radiation therapy, although fatigue is a common side effect. It’s best to discuss your work schedule with your radiation oncologist to determine what is feasible for you.

Q5: What can I do to manage skin reactions during radiation therapy?

Gentle skin care is essential. Avoid harsh soaps, lotions, and deodorants in the treated area. Your radiation oncology team will provide specific recommendations for creams and ointments to alleviate skin irritation.

Q6: Is radiation therapy safe?

Radiation therapy is a well-established and effective treatment for breast cancer. While there are potential side effects, the benefits of radiation therapy in preventing recurrence and improving survival often outweigh the risks. Sophisticated techniques like IMRT and proton therapy are designed to minimize exposure to healthy tissues.

Q7: How will my radiation oncologist determine the appropriate type of radiation for me?

Your radiation oncologist will consider various factors, including the stage of your cancer, the type of surgery you had, your overall health, and your personal preferences. They will discuss the risks and benefits of each type of radiation and help you make an informed decision.

Q8: What is a radiation oncologist and what is their role in my treatment?

A radiation oncologist is a doctor who specializes in using radiation therapy to treat cancer. They will oversee your entire radiation treatment, from planning to delivery to follow-up care. They work closely with other members of your cancer care team, such as your surgeon and medical oncologist.

Q9: What is the difference between radiation therapy and chemotherapy?

Radiation therapy targets cancer cells locally, using high-energy rays to destroy them in a specific area. Chemotherapy, on the other hand, is a systemic treatment that uses drugs to kill cancer cells throughout the body.

Q10: Can I have radiation therapy if I have breast implants?

Yes, radiation therapy can be given to patients with breast implants. However, special considerations may be needed to ensure the radiation is delivered effectively and to minimize the risk of complications, such as capsular contracture. Your radiation oncologist will work with your plastic surgeon to develop a treatment plan that is safe and effective.

Q11: What happens if radiation therapy doesn’t work?

If radiation therapy is not effective in controlling the cancer, other treatment options may be considered, such as chemotherapy, hormone therapy, targeted therapy, or surgery. Your oncologist will discuss these options with you and help you determine the best course of action.

Q12: Where can I find more information and support related to breast cancer and radiation therapy?

Several reputable organizations provide information and support for breast cancer patients, including the American Cancer Society, the National Breast Cancer Foundation, and the Susan G. Komen Foundation. Your oncology team can also provide you with resources and referrals to support groups and other services. Remember to always discuss your specific treatment plan and any concerns with your medical team.