Radiation Therapy

Women who undergo a lumpectomy in treatment of their breast cancer need to complete breast radiation to help prevent the cancer from recurring in the breast. The radiation kills the individual cancer cells that that we know exist in the breast tissue around the tumor but we cannot see with the microscope.  Traditionally, the radiation is applied to the whole breast in brief exposures five days a week for six weeks. Therapy generally starts about a month following the breast operation, or after chemotherapy.  Radiation therapy does not hurt, nor does it make one sick or lose hair. Women can develop some skin changes similar to a sunburn but these changes resolve with time.  The underlying heart and lungs receive minimal exposure to the radiation beams so the risk of a serious complication involving these vital organs is extremely small.  We have a long experience with this technique and it is very effective at controlling the disease in the breast.  It is considered a standard therapy for any women who undergoes a lumpectomy for her breast cancer.

Newer Radiation Options

Because traditional radiation therapy requires approximately six weeks of a daily treatment and affects the entire breast, other techniques requiring less time and radiation exposure have been developed.  Small very favorable cancers may be well treated with these more localized radiation techniques.   "Accelerated Partial Breast Irradiation" with a Mammosite balloon catheter is one such technique. With this technique, a balloon shaped device is placed in the space left in your breast when the tumor is surgically removed.  The balloon is attached to a flexible tube that allows delivery of radiation directly into the tumor bed through the balloon. Using this technique, radiation therapy generally begins within a week after the breast operation and is delivered twice daily for 5 days, and then the balloon is removed.   Experience to date suggests that the technique results in similar control of local recurrences as the whole breast approach, but with a much shorter time frame. This feature has obvious appeal to both patients and physicians alike, but it is important to make sure that local control of the disease over the long term is not compromised by the more limited approach. To this end, a formal clinical rial comparing the two techniques directly is ongoing and women are invited to participate in order to answer this critical question.

Another technique for more limited breast radiation  is actually performed in a single treatment delivered in the operating room as part of the lumpectomy.  This technique known as "Intraoperative Radiotherapy" has been studied in a clinical trial setting and when used in women with small favorable breast cancers, it has been shown to be equivalent to traditional whole breast radiation in terms of controlling disease without causing undo side effects. These early results are certainly promising.  However, the technique requires special equipment that is not  available at every hospital the way other techniques are.  Hopefully with the growing evidence for its safety and effectiveness, the technique  will become more widely available to all women whose cancers qualify for it. 

Post Mastectomy Radiation

Women who undergo mastectomy in treatment of their breast cancer generally do not need to have radiation.  However, there are certain circumstances under which we know that a cancer can come back even after a mastectomy, and we can reduce that chance by radiating the chest wall after the mastectomy.  These circumstances include having a tumor that is large (greater than 5 centimeters) or having 4 or more lymph nodes containing disease. In some instances, those with lesser lymph node involvement ( 1-3 nodes involved) may also benefit from radiation after mastectomy if their breast tumor has other aggressive features.  Radiation to a mastectomy that has been reconstructed with an implant can dramatically affect the appearance of that  breast and can cause complications that may result in implant loss.   As such, it is important for any patient considering mastectomy with reconstruction to discuss the need for post mastectomy radiation in order to make the best decision about her reconstructive options.

Copyright 2008 by Janet Grange, MD