Radiation Therapy for Breast Cancer

The goal of radiation therapy is to destroy any cancer cells that remain after surgery. Over the last several years, radiation technologies and delivery techniques have advanced steadily. Current tools allow radiation oncologists to customize therapies for women in a variety of situations — from early stage cancer to advanced disease.

Radiation oncologists in the Breast Cancer Program are cancer specialists who focus exclusively on women with breast disease. They are national leaders in the development of new methods for delivering therapeutic radiation and improving patients’ quality of life.

Radiation After Lumpectomy

Radiation therapy plays a key role in helping many women avoid mastectomy. After a lumpectomy to remove a cancerous tumor, a patient has radiation treatments intended to eliminate any remaining cancer cells. For carefully selected patients, lumpectomy with radiation is as effective as mastectomy at preventing cancer from coming back (recurrence).

The standard approach is to deliver external beam radiation to the entire breast (whole breast irradiation). Patients typically receive treatments every weekday for one to five weeks.

Some patients with early stage cancer can have partial breast irradiation. In this approach, radiation is concentrated on the part of the breast nearest the tumor cavity. Because healthy tissue is avoided, the radiation treatment can be accelerated and treatment is shorter Partial breast irradiation can be completed within five treatments.

Since it can be delivered in one week , it is more convenient for most women, especially those who live at a distance. Doctors in the Breast Cancer Program are national leaders in developing innovative ways to deliver partial breast irradiation.

Radiation After Mastectomy

Some women who have a mastectomy still need to receive radiation therapy. These may include patients with large tumors or a cancer that has spread to the lymph nodes of the armpit and chest. Decisions about the need for radiation after mastectomy may depend on when and what type of chemotherapy is received as part of breast cancer treatment. Radiation after a mastectomy may be delivered before or after any breast reconstruction surgery.

3D Conformal External Beam Radiation

A tumor cavity or the breast region can be treated with radiation delivered from an external source. Three-dimensional (3D) conformal therapy uses radiation generated by a linear accelerator. Several radiation beams generated from different angles are focused on the area where the tumor was removed. Radiation may be delivered to the breast while a patient lies on their back (supine) or on their front (prone). 

Image-Guided Intensity Modulated Radiation Therapy

Intensity Modulated Radiation Therapy (IMRT) is another technique used to help spare normal tissue from radiation. It may be used for partial breast radiation or when treating the lymph nodes around the breast or chest. It allows shaping of the radiation to outline the areas of treatment while avoiding radiation dose to normal tissues like the untreated breast, heart, and lungs. Your radiation oncologist will help determine if you need IMRT.

Proton Radiation for Breast Cancer

Most patients receiving radiation therapy for breast cancer don’t require proton therapy. However, there may be some patients who may benefit from this treatment. Your radiation oncologist can review if proton therapy would be beneficial in your case.

Breast Radiation Therapy Side Effects

Radiation therapy is an effective treatment for breast cancer, but it comes with side effects. They usually fall into short-term (during or soon after treatment) and long-term (months to years later).

Common Short-Term Side Effects

These usually build up gradually over the weeks of treatment:

• Fatigue is very common, and it can feel deep and cumulative like having a cold or the flu
• Skin changes like redness, darkening, dryness, itching, and peeling — kind of like a sunburn often occurs. Some people can experience areas of blistering.
  • Breast or chest discomfort like swelling, tenderness, tightness, or heaviness. The discomfort is usually mild, and most patients don’t require even mild pain medications such as Tylenol.
• Hair loss or diminished sweating in the treated area such as the chest or under the armpit. This may be permanent at times.
• Mild sore throat or cough if radiation is near the upper chest or lymph nodes.

Rare Short-Term Side Effects

• Pain requiring a strong pain medication
• Nausea (not common with modern breast radiation)
• Temporary breast firmness or warmth
• Skin infection if the skin breaks down

Common Long-Term Side Effects

• Breast or chest firmness, shrinkage or scar tissue formation (tends to be mild in most people). For the overwhelming majority of patients, cosmetic changes from radiation cannot be detected when fully clothed. Most patients are very satisfied with the cosmetic results of treatment.
• Reduced range of motion in the shoulder or arm on the side of radiation (tends to be mild in most people). Physical therapy, exercise and stretching may be recommended after treatment.

Rare Long-Term Side Effects

• Damage to the ribs, esophagus, heart and lungs requiring treatment. 
• Risk of a second cancer due to exposure to ionizing radiation that may occur years after treatment