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    Radiation for Breast Cancer

    Some women with breast cancer will need radiation treatment. Learn about the different types of radiation therapies and the side effects.

    Radiation for Breast Cancer

    Radiation therapy is treatment with high-energy rays (or particles) that destroy cancer cells. Some women with breast cancer will need radiation, in addition to other treatments.

    Depending on the breast cancer's stage and other factors, radiation therapy can be used in several situations:

    After breast-conserving surgery (BCS), to help lower the chance that the cancer will come back in the same breast or nearby lymph nodes.

    After a mastectomy, especially if the cancer was larger than 5 cm (about 2 inches), if cancer is found in many lymph nodes, or if certain surgical margins, such as the skin or muscle, have cancer cells.

    If cancer has spread to other parts of the body, such as the bones, spinal cord, or brain.

    Types of radiation therapy for breast cancer

    The main types of radiation therapy that can be used to treat breast cancer are:

    External beam radiation therapy

    Brachytherapy

    External beam radiation therapy (EBRT)

    EBRT is the most common type of radiation therapy for women with breast cancer. A machine outside the body focuses the radiation on the area affected by the cancer.

    Which areas need radiation depends on whether you had a mastectomy or breast-conserving surgery (BCS) and if the cancer has reached nearby lymph nodes.

    If you had a mastectomy and no lymph nodes had cancer cells, radiation will be focused on the chest wall, the mastectomy scar, and the places where any drains exited the body after surgery.

    If you had BCS, you will most likely have radiation to the entire breast (called whole breast radiation). An extra boost of radiation to the area in the breast where the cancer was removed (called the tumor bed) is often given if there is a high risk of the cancer coming back. The boost is often given after the treatments to the whole breast have ended. It uses the same machine, with lower amounts of radiation aimed at the tumor bed. Most women don’t notice different side effects from boost radiation than from whole breast radiation.

    If cancer was found in the lymph nodes under the arm (axillary lymph nodes), this area may be given radiation, as well. Sometimes, the area treated might also include the nodes above the collarbone (supraclavicular lymph nodes) and the nodes beneath the breast bone in the center of the chest (internal mammary lymph nodes).

    If you will need external beam radiation therapy after surgery, it is usually not started until your surgery site has healed, which often takes a month or longer. If you are getting chemotherapy as well, radiation treatments are usually delayed until chemotherapy is done. Some treatments after surgery, like hormone therapy or HER2 targeted therapy, can be given at the same time as radiation.

    Types and schedules of external beam radiation for breast cancer

    Whole breast radiation

    Radiation to the entire affected breast is called whole breast radiation.

    The standard schedule for getting whole breast radiation is 5 days a week (Monday through Friday) for about 6 to 7 weeks.

    Another option is hypofractionated radiation therapy where the radiation is also given to the whole breast, but in larger daily doses (Monday through Friday) using fewer treatments (typically for only 3 to 4 weeks). For women who have had breast-conserving surgery (BCS) and whose cancer has not spread to underarm lymph nodes, this schedule has been shown to be just as good at keeping the cancer from coming back in the same breast as giving the radiation over longer periods of time. It might also lead to fewer short-term side effects.

    Accelerated partial breast irradiation

    After whole breast radiation or even after surgery alone, most breast cancers tend to come back very close to the area where the tumor was removed (tumor bed). For this reason, some doctors are using accelerated partial breast irradiation (APBI) in selected women to give larger doses over a shorter time to only one part of the breast (the tumor bed) compared to the entire breast (whole breast radiation). Since more research is needed to know if these newer methods will have the same long-term results as standard radiation, not all doctors use them. There are several different types of accelerated partial breast irradiation:

    Intraoperative radiation therapy (IORT): In this approach, a single large dose of radiation is given to the area where the tumor was removed (tumor bed) in the operating room right after BCS (before the breast incision is closed). IORT requires special equipment and is not widely available.3D-conformal radiotherapy (3D-CRT): In this technique, the radiation is given with special machines so that it is better aimed at the tumor bed. This spares more of the surrounding normal breast tissue. Treatments are given twice a day for 5 days or daily for 2 weeks.Intensity-modulated radiotherapy (IMRT): IMRT is like 3D-CRT, but it also changes the strength of some of the beams in certain areas. This gets stronger doses to certain parts of the tumor bed and helps lessen damage to nearby normal body tissues.Brachytherapy: See brachytherapy below.

    Women who are interested in these approaches may want to ask their doctor about taking part in clinical trials of accelerated partial breast irradiation.

    Source : www.cancer.org

    Radiation Therapy

    Treatment Options

    Radiation Therapy

    Radiation therapy (radiotherapy) is a treatment that uses high-energy radiation to kill cancer cells and shrink tumors.

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    Radiation therapy — also called radiotherapy — is a treatment that uses high-energy radiation to kill cancer cells and shrink tumors.

    The radiation treatment procedure is painless, but it may cause some skin discomfort over time. When treating early-stage breast cancer, radiation therapy is often given after surgery. Surgery is done to remove the cancer, and radiation is done to destroy any cancer cells that may remain after surgery. This helps lower the risk of the cancer coming back (recurrence).

    Radiation therapy also can be used to treat:

    breast cancer that can’t be removed with surgery, which doctors call unresectable

    metastatic breast cancer, which is breast cancer that has spread to parts of the body away from the breast, such as the bones, lungs, brain, or liver

    How does radiation therapy work?

    Radiation therapy uses special high-energy X-rays or particles to damage a cancer cell’s DNA. When a cancer cell’s DNA is damaged, it can’t divide successfully and it dies.

    Radiation therapy damages both healthy cells and cancer cells in the treatment area. Still, radiation affects cancer cells more than normal cells. Cancer cells grow and divide faster than healthy cells and also are less organized. Because of this, it's harder for cancer cells to repair the damage done by radiation. So cancer cells are more easily destroyed by radiation, while healthy cells are better able to repair themselves and survive the treatment.

    The treatment area may include the breast area, the lymph nodes, or another part of the body if the cancer has spread.

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    Radiation treatments are carefully planned to make sure you receive the greatest benefits and the fewest side effects possible.

    Types of radiation therapy

    There are two main types of radiation therapy used to treat breast cancer:

    External Beam Radiation

    External beam radiation is given by a large machine called a linear accelerator. The machine aims a beam of radiation at the treatment area.

    Learn more

    Brachytherapy or Internal Radiation

    Internal radiation, called brachytherapy by doctors, uses a radioactive substance sealed in seeds or tiny tubes that are placed inside your body directly into the cancer or the place where the cancer was.

    Learn more

    Intraoperative Radiation Therapy

    Another type of radiation therapy, called intraoperative radiation therapy, is a type of partial-breast radiation. With intraoperative radiation therapy, the entire course of radiation is delivered at one time during breast cancer surgery.

    Learn more

    A newer type of radiation therapy, called proton therapy or proton beam therapy, uses particles called protons rather than X-rays to treat cancer. Proton therapy for breast cancer is not the standard of care, is still being studied, and is not available at all treatment facilities. Read more about proton therapy.

    When is radiation therapy used?

    Radiation therapy can be used to treat all stages of breast cancer.

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    Pregnant women should not have radiation therapy because it can harm the unborn baby.

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    Treatment for Breast Cancer During Pregnancy

    Radiation therapy after lumpectomy

    Radiation therapy is recommended for most people who have lumpectomy to remove breast cancer. Lumpectomy is sometimes called breast-conserving surgery. The goal of radiation after lumpectomy is to destroy any individual cancer cells that may have been left in the breast after the tumor was removed. This reduces the risk of the cancer coming back (recurrence) and the risk of passing away from breast cancer.

    Here’s a good analogy for understanding the role of radiation therapy after surgery: “If you drop a glass on the kitchen floor, you must first sweep up all of the big pieces of glass and throw them away — you can think of breast surgery in this way,” says Marisa Weiss, M.D., founder and chief medical officer of Breastcancer.org and director of breast radiation oncology at Lankenau Medical Center. “Radiation therapy is like vacuuming the area after you sweep, getting into the corners and under the furniture, to get rid of any tiny shards of glass that might be left behind.”

    Radiation therapy after mastectomy

    Radiation therapy may be recommended after mastectomy to destroy any cancer cells that may be left behind after the surgery. During mastectomy, it's difficult for surgeons to take out every cell of breast tissue.

    Your doctor will look at your pathology report and calculate your risk of breast cancer recurrence based on a number of factors, including:

    the number of lymph nodes involved

    the size of the cancer

    if cancer is at any of the edges of the surgery (positive margins)

    If you have a high risk of recurrence, your doctor may recommend radiation after mastectomy to the area where the breast tissue used to be and sometimes to the nearby lymph node areas.

    Source : www.breastcancer.org

    How Many Radiation Treatments Expected for Breast Cancer?

    Radiation Treatment for Breast Cancer: What to Expect

    Medically reviewed by Christina Chun, MPH — Written by Annamarya Scaccia — Updated on April 25, 2017

    Overview

    Some people receive radiation treatments for breast cancer after they’ve had surgery, or if their cancer has spread to other body parts. Radiation treatment uses high-energy rays to kill breast cancer cells. The rays are directed at the area where the tumor appeared.

    Two common types of radiation treatment are external beam radiation and internal beam radiation. When radiation treatment starts depends on if you’ve had chemotherapy. It also depends on if you’ve had a mastectomy or breast-conserving surgery. Radiation can start after two weeks, to a month or later. Radiation treatment often lasts more than a month. The number of sessions depends on the type of radiation treatment you have.

    External beam breast cancer radiation

    External beam radiation is the most common kind of radiation treatment for breast cancer. It’s a painless treatment, like getting an X-ray. A doctor will place a machine on the outside of your body and aim the radiation beams at the area of the cancer. Your doctor will figure out where to aim the rays and how much radiation to use before each treatment. They will mark the area with temporary or permanent ink.

    Each treatment only lasts a few minutes. The session setup will take longer. External radiation treatment happens five days a week for about five to seven weeks. It’s the longest type of radiation treatment available.

    Short-term side effects of external radiation include:

    fatigue

    red, itchy, dry or tender skin

    heavy or swollen breasts

    red, discolored, blistered, or peeling skin

    Potential long-term side effects include:

    smaller and firmer breasts

    breastfeeding problems

    nerve damage

    swelling and pain in the arm or chest

    weakened and fractured ribs (rare)

    future cancer in the inner lining of your blood vessels (rare)

    External radiation does not leave radiation in your body. You will not be radioactive during or after treatment.

    Internal breast cancer radiation

    Internal breast cancer radiation is also known as brachytherapy. You doctor will place a device that contains radioactive seeds in the area of the breast where the cancer was found. For a short time, internal radiation targets only the area where breast cancer is most likely to return. This causes fewer side effects. The treatment takes a week to complete.

    If you’ve had breast-saving surgery, a doctor may treat you with both internal and external radiation to increase the boost of radiation. Doctors may only perform internal radiation as a form of accelerated partial breast radiation to speed up treatment.

    Potential side effects of internal radiation include:

    nausea redness breast pain bruises infection

    breakdown of breast fat tissue

    weakness and fracture of the ribs (rare)

    Brachytherapy via implantable device

    There are two common types of internal radiation treatment: interstitial brachytherapy and intracavitary brachytherapy.

    During interstitial brachytherapy, a doctor will insert several small tubes into your breast where the cancer was removed. The tubes deliver radioactive pellets to that area a few times each day over several days. This procedure is not commonly used today.

    Intracavitary brachytherapy is the most common type of internal breast cancer radiation. Your doctor will place a tube-like device into your breast to send radiation to the location of the cancer. The end of the device expands in the breast to keep it in place, while the other end sticks out of the breast. Outpatient treatment sessions happen twice a day for five days.

    Side effects of intracavitary brachytherapy may include:

    redness bruises infection breast pain

    breakdown of breast fat tissue

    weakness and fracture of the ribs (rare)

    Intracavitary brachytherapy has shown good results, but there needs to be more research done to prove its benefits. Study findings published in the Journal of the American Medical Association (JAMA)

    Trusted Source Trusted Source

    reported researchers found an association between treatment with intracavitary internal radiation and new cases of mastectomy treatment. Researchers collected data from a cohort of women aged 67 years and older with breast cancer.

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    Intraoperative radiation

    Intraoperative radiation (IORT) is a treatment option given after the removal of cancer cells during surgery. A doctor will direct a single, high-dose radiation beam on the part of the exposed breast tissue where the cancer appeared. Doctors will shield normal tissues close to the area from radiation exposure.

    Source : www.healthline.com

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