Treatments

Treatment Options

Radiation Therapy

Radiation therapy, also called radiotherapy, is widely utilized in the modern treatment of breast cancer. Radiation therapy can be used to improve rates of breast cancer survival and it can lower rates of breast cancer recurrence (ref. 1-2). Radiation is effective in the treatment of patients with positive lymph nodes. It is also used to treat the chest wall following mastectomy for breast cancers larger than 2 inches or 5 cm after mastectomy (ref. 3). However, one of the most important benefits of radiation therapy is that it provides women with early-stage breast cancers the option of avoiding a mastectomy.

How Radiation Works

Radiation therapy uses high-energy particles such as X-rays or protons to kill cancer cells (ref. 4). Rapidly growing cancer cells are more vulnerable to the effects of radiation than are normal cells. As a result, radiation therapy can kill breast cancer cells with limited impact on surrounding breast structures such as the heart or lungs. The radiation takes approximately 15 minutes to complete. (ref. 1).

Overview of Treatment Options

There are two basic approaches to radiating the breast following surgical removal of the cancer. The first option is to radiate the entire breast. This approach is referred to as whole breast irradiation or WBI. The second option is to limit the radiation to the area of the breast where the tumor was located prior to its removal. The second approach is referred to as partial breast irradiation or PBI.

Whole Breast Irradiation

In this approach, the surgeon first removes the breast cancer along with a rim of normal tissue, which is referred to as the tumor margin. This procedure is referred to as a lumpectomy or partial mastectomy. Following the lumpectomy, the patient is referred to a Radiation Oncologist who reviews treatment options (ref. 5). Women who choose to have whole breast radiation are scheduled to start radiation treatments approximately 4 weeks following the lumpectomy. Radiation treatments are typically performed once daily Monday through Friday. A course of treatment typically takes 5-7 weeks. The radiation is delivered to the breast from a machine outside the body. This approach is referred to as external beam radiation therapy (ref. 1). The procedure is well tolerated. The most common symptoms following whole breast radiation are redness of the skin and fatigue. The cosmetic results are typically good to excellent. Survival rates for lumpectomy plus whole breast radiation are equivalent to survival rates for total mastectomy (ref. 1)

Accelerated Whole Breast Irradiation

One of the major drawbacks of whole breast irradiation is the time it takes to complete a course of therapy. Recent advances in technology allow for the radiation therapy to be completed in 1 to 4 weeks (ref. 6). In this approach, a more concentrated dose of radiation is given over a shorter time period. Studies confirm that the clinical results of accelerated whole breast irradiation are essentially the same as for women who have had the standard six-week course of therapy. It is now the procedure of choice for most women who choose to receive whole breast irradiation. (ref. 6).

Partial Breast Irradiation

In partial breast irradiation, the treatment is limited to the area of the breast surrounding the lumpectomy cavity. The procedure is well-tolerated, and cosmetic results are typically excellent. There are three methods of performing partial breast irradiation.

Method 1: External Beam Partial Breast Irradiation Therapy

In this option, the radiation is delivered from an outside source as it is with whole breast irradiation (ref. 7-10). The treatment is directed to the lumpectomy cavity plus a surrounding rim of normal breast tissue.

Method 2: Brachytherapy or Radium Seed Implant

Brachytherapy, also known as internal breast irradiation, refers to using radioactive seeds or pellets to deliver the radiation to the breast (ref. 11-12). There are two approaches to using radium seeds. The first approach is referred to as intracavity irradiation. In this approach, a specially designed catheter is placed into the lumpectomy cavity at the time of the lumpectomy or shortly thereafter.

The catheter has one or more side ports through which the radium seeds can be inserted. The radium seeds are typically placed twice daily for one week. The catheter is removed after the last treatment. The second approach is referred to as interstitial radiation (ref. 13). In this approach, the radiation oncologist places a series of small catheters into the breast tissue one to two weeks following lumpectomy. The catheters are strategically placed to surround the lumpectomy cavity. Radium seeds are inserted into the small tubes twice daily for one week. The catheters are removed after the final radiation treatment.

Method 3: Intraoperative Irradiation Therapy (IORT)

In this treatment option, the radiation is delivered while the patient is still in the operating room following a lumpectomy (ref. 14-16). Intraoperative radiation targets the tissue surrounding the lumpectomy cavity. Following a single dose of radiation, the catheter is removed, and the incision is closed. The patient is discharged on the same day. This procedure requires special equipment and is not available in all centers.

Conclusion

A major challenge for most newly diagnosed breast cancer patients is to consult with the radiation oncologist as soon as possible after the diagnosis has been made. Newly diagnosed patients need to be fully informed about radiation treatment options. Some patients may want a second opinion. The sooner the patient is referred to the radiation oncologist the easier it is to make an informed decision on what is the best treatment option for the individual patient.

If you have questions about the issue of radiation therapy, contact us at info@thepinkjourneyfoundation.org.

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