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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:
The main types of radiation therapy that can be used to treat breast cancer are:
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 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.
Radiation to the entire affected breast is called whole breast radiation.
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:
Women who are interested in these approaches may want to ask their doctor about taking part in clinical trials of accelerated partial breast irradiation.
If you had a mastectomy and none of the lymph nodes had cancer, radiation will be given to the entire chest wall, the mastectomy scar, and the areas of any surgical drains. It is typically given every day, 5 days a week, for 6 weeks.
Whether or not you have had BCS or a mastectomy, if cancer was found in the lymph nodes under the arm (axillary lymph nodes), this area may be given radiation. In certain cases, the lymph nodes above the collarbone (supraclavicular lymph nodes) and behind the breastbone in the center of the chest (internal mammary lymph nodes) will also get radiation along with the underarm nodes. It is typically given daily 5 days a week for 6 weeks at the same time as the radiation to the breast or chest wall is given.
The main short-term side effects of external beam radiation therapy to the breast are:
Your health care team may advise you to avoid exposing the treated skin to the sun because it could make the skin changes worse. Most skin changes get better within a few months. Changes to the breast tissue usually go away in 6 to 12 months, but it can take longer.
External beam radiation therapy can also cause side effects later on:
Brachytherapy, also known as internal radiation, is another way to deliver radiation therapy. Instead of aiming radiation beams from outside the body, a device containing radioactive seeds or pellets is placed into the breast tissue for a short time in the area where the cancer had been removed (tumor bed).
For certain women who had breast-conserving surgery (BCS), brachytherapy can be used by itself (instead of radiation to the whole breast) as a form of accelerated partial breast irradiation. Tumor size, location, and other factors may limit who can get brachytherapy.
This is the most common type of brachytherapy for women with breast cancer. A device is put into the space left from BCS and is left there until treatment is complete. There are several different devices available, most of which require surgical training for proper placement. They all go into the breast as a small catheter (tube). The end of the device inside the breast is then expanded like a balloon so that it stays securely in place for the entire treatment. The other end of the catheter sticks out of the breast. For each treatment, one or more sources of radiation (often pellets) are placed down through the tube and into the device for a short time and then removed. Treatments are typically given twice a day for 5 days in an outpatient setting. After the last treatment, the device is deflated and removed.
In this approach, several small, hollow tubes called catheters are inserted into the breast around the area where the cancer was removed and are left in place for several days. Radioactive pellets are inserted into the catheters for short periods of time each day and then removed. This method of brachytherapy has been around longer (and has more evidence to support it), but it is not used as much.
Early studies of intracavitary brachytherapy as the only radiation after BCS have had promising results as far as having at least equal cancer control compared with standard whole breast radiation, but may have more complications including poor cosmetic results. Studies of this treatment are being done and more follow-up is needed.
As with external beam radiation, intracavitary brachytherapy can have side effects, including:
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Last Revised: October 27, 2021