How Does Radiation Work For Breast Cancer

What Are The Cosmetic Results Of Breast Conservation Therapy

Eighty percent to 90 percent of women treated with modern surgery and radiotherapy techniques have excellent or good cosmetic results that is, little or no change in the treated breast in size, shape, texture or appearance compared with what it was like before treatment.

Patients with large breasts seem to have greater shrinkage of the breast after radiation therapy than do patients with smaller breasts. However, this problem usually can be overcome with the use of higher x-ray energies or with IMRT. Partial breast radiation using brachytherapy can also be considered if the patient has a small early-stage tumor. This treatment is still undergoing clinical investigation. Certain single institution studies on brachytherapy and intraoperative radiation have shown some promising results. You would need to discuss this with your doctor before or shortly after surgery to determine if you qualify for partial breast radiation.

When Is Radiation Therapy Recommended

Radiation therapy is recommended:

• after breast-conserving surgery
• after a mastectomy if pathology results suggest the risk of recurrence is high or if the cancer has spread to the lymph nodes you may have radiation to the chest wall and lymph nodes above the collarbone
• if the sentinel node is affected you may have radiation to the armpit instead of axillary dissection.

You will usually start radiation therapy within eight weeks of surgery. If youre having chemotherapy after surgery, radiation therapy will begin about three to four weeks after chemotherapy has finished. In some circumstances, radiotherapy may be offered after neoadjuvant chemotherapy and before surgery.

Abemaciclib Palbociclib And Ribociclib And Hormone Therapy

The CDK4/6 inhibitors FDA-approved for metastatic breast cancer treatment are:

• Abemaciclib
• Palbociclib
• Ribociclib

CDK4 and CDK6 are enzymes important in cell division. CDK4/6 inhibitors are a class of drugs designed to interrupt the growth of cancer cells.

Although the CDK4/6 inhibitors abemaciclib, palbociclib and ribociclib have not been compared directly to one another, studies show similar results with each drug .

A CDK4/6 inhibitor in combination with hormone therapy can be used to treat hormone receptor-positive, HER2-negative metastatic breast cancers. Compared to treatment with hormone therapy alone, this combination can give people more time before the cancer spreads and increase overall survival .

The CDK4/6 inhibitor abemaciclib may also be used alone to treat hormone receptor-positive, HER2-negative cancers that have progressed during past hormone therapy and chemotherapy .

Abemaciclib, palbociclib and ribociclib are pills.

The table below lists some possible side effects for CDK4/6 inhibitors.

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How Long Will I Have To Take It

This will depend on your individual circumstances, but letrozole is usually taken for five to ten years.

Some people start taking letrozole after a few years of taking the hormone therapy drug tamoxifen.

If youre taking letrozole to treat breast cancer that has come back or spread to another part of the body, youll usually take it for as long as its keeping the cancer under control.

When Should I Call The Doctor

You should call your healthcare provider if you experience:

• Severe skin or breast inflammation.
• Signs of infection, such as fever, chills or weeping skin wounds.

A note from Cleveland Clinic

Radiation therapy can lower the risk of cancer recurrence and cancer spread. The treatment affects everyone differently. Most side effects go away in a few months after treatments end. Some problems last longer. You should tell your healthcare provider about any problems you have while getting treatment. Your provider may change the therapy slightly to minimize issues while still effectively treating the cancer.

Last reviewed by a Cleveland Clinic medical professional on 03/19/2021.

References

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Types Of Radiation For Breast Cancer

External-beam radiation therapy is the most common form of radiation treatment for breast cancer. In this approach, a machine called a linear accelerator, or LINAC, produces radiation. The radiation is delivered as precisely targeted x-ray beams.

At MSK, we deliver external-beam radiation therapy in a variety of ways. These approaches are designed to tailor the radiation treatments as much as possible to the exact size and location of your cancer, specifically aiming at tumor cells while avoiding side effects.

We also offer internal radiation therapy in the form of brachytherapy. Brachytherapy is generally reserved for women receiving partial-breast irradiation after lumpectomy.

Learn more about the techniques our breast cancer radiation team frequently recommends.

In this method, patients lie on their stomach . Radiation is directed to the affected breast as it hangs through an opening in the treatment table. This approach may reduce radiation exposure to nearby vital organs, such as the heart and lungs. Prone breast radiation has been shown to reduce radiation burn on the skin. Research has also shown that this therapy is especially useful for women with large breasts.

In this approach, our experienced radiation therapists guide women with cancer in the left breast through a breathing technique called deep inspiration breath hold . It minimizes the risk of injury to the heart.

What Is Stage Ii Breast Cancer

Stage II describes cancer that is in a limited region of the breast but has grown larger. It reflects how many lymph nodes may contain cancer cells. This stage is divided into two subcategories.

Stage IIA is based on one of the following:

• Either there is no tumor in the breast or there is a breast tumor up to 20 millimeters , plus cancer has spread to the lymph nodes under the arm.
• A tumor of 20 to 50 millimeters is present in the breast, but cancer has not spread to the lymph nodes.

Stage IIB is based on one of these criteria:

• A tumor of 20 to 50 millimeters is present in the breast, along with cancer that has spread to between one and three nearby lymph nodes.
• A tumor in the breast is larger than 50 millimeters, but cancer has not spread to any lymph nodes.

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Is Radiation Therapy Necessary If The Margins Of The Removed Tissue Are Clear

Many studies have reviewed this approach for patients with invasive cancers. Nearly all show that the risk of relapse in the breast is much higher when radiation is not used than when it is . When breast cancer re-occurs locally after breast conservation surgery, patients may then need to have a mastectomy to be cured. Because having breast cancer reappear in this way is a very traumatic psychological event, and because not everyone who has a recurrence in the breast can be cured, radiation therapy after lumpectomy has become a standard part of breast-conserving therapy.

There are several recent studies in which older patients with small, favorable invasive cancers have had a low risk of local relapse when treated with lumpectomy and hormonal therapy without radiation therapy. There is still uncertainty about the long-term results with this approach or about which individuals will do best without radiation therapy. This issue should be discussed in detail with your doctor.

Circulating Tumor Cell Test

A circulating tumor cell test can check for blood biomarkers that show whether normal cells are transforming into cancer cells. CTC tests can help diagnose and screen patients who have a risk of developing cancer, such as a family history of the disease.

CTC tests are helpful in the early detection of cancer as well as monitoring treatment effectiveness over time. The only test currently approved for this purpose is called CellSearch CTC, which offers different prostate, colorectal, and breast cancer assays.

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To Treat Symptoms Caused By Advanced Cancer

Sometimes cancer has spread too much to be cured. But some of these tumors can still be treated to make them smaller so that the person can feel better. Radiation might help relieve problems like pain, trouble swallowing or breathing, or bowel blockages that can be caused by advanced cancer. This is called palliative radiation.

What To Expect During Radiation Treatments

Treatments are usually given five days a week for six to seven weeks. If the goal of treatment is palliative treatment will last 2-3 weeks in length. Using many small doses for daily radiation, rather than a few large doses, helps to protect the healthy cells in the treatment area. The break from treatment on weekends allows the normal cells to recover.

It is very important to finish all sessions of radiation therapy. It is important not to miss or delay treatments because it can lessen how well the radiation kills tumor cells.

The radiation therapy technologist may ask you to change into a gown before treatment. It is a good idea to wear clothing that is easy to pull down, adjust, or remove when coming for treatments.

During the actual treatment sessions you will be in the treatment room between 10-30 minutes. You will be receiving radiation for 1-2 minutes of that time.

You will be asked to lie on a hard, moveable bed. The RTT will use the marks on your skin to exactly position the machine and table. In some instances, special blocks or shields are used to protect normal organs. You may be positioned using special holders, molds or boards.

It is extremely important to remain still during the radiation treatments. Breathe normally during treatments. You do not need to hold your breath. You will not feel anything during the treatment. Radiation is painless. You will not see, hear, or smell radiation.

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Proton Beam Radiation Therapy

Proton beam radiation uses beams of protons instead of X-rays. A proton is a particle with a positive electric charge that is in the nuclei of all atoms.

X-rays release energy both before and after they hit their target. But protons release their energy only after traveling a certain distance. So doctors think protons may be able to deliver more radiation directly to the treatment area while possibly doing less damage to nearby healthy tissue. But this is still being studied.

Right now, proton beam radiation is only being used in clinical trials to treat breast cancer. The machines needed to deliver protons are very expensive and are not widely available.

If youre interested in being treated with proton beam therapy, talk to your doctor to find a clinical trial that would be a good fit for your unique situation.

If Youre Getting Radiation Therapy To The Brain

People with brain tumors often get stereotactic radiosurgery if the cancer is in only one or a few sites in the brain. Side effects depend on where the radiation is aimed. Some side effects might show up quickly, but others might not show up until 1 to 2 years after treatment. Talk with your radiation oncologist about what to watch for and when to call your doctor.

If the cancer is in many areas, sometimes the whole brain is treated with radiation. The side effects of whole brain radiation therapy may not be noticeable until a few weeks after treatment begins.

Radiation to the brain can cause these short-term side effects:

• Headaches
• Trouble with memory and speech
• Seizures

Some of these side effects can happen because radiation has caused the brain to swell. Medicines are usually given to prevent brain swelling, but its important to let your cancer care team know about headaches or any other symptoms. Treatment can affect each person differently, and you may not have these particular side effects.

Radiation to the brain can also have side effects that show up later usually from 6 months to many years after treatment ends. These delayed effects can include serious problems such as memory loss, stroke-like symptoms, and poor brain function. You may also have an increased risk of having another tumor in the area, although this is not common.

Talk with your cancer care team about what to expect from your specific treatment plan.

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Early And Late Effects Of Radiation Therapy

• Early side effects happen during or shortly after treatment. These side effects tend to be short-term, mild, and treatable. Theyre usually gone within a few weeks after treatment ends. The most common early side effects are fatigue and skin changes. Other early side effects usually are related to the area being treated, such as hair loss and mouth problems when radiation treatment is given to this area.
• Late side effects can take months or even years to develop. They can occur in any normal tissue in the body that has received radiation. The risk of late side effects depends on the area treated as well as the radiation dose that was used. Careful treatment planning can help avoid serious long-term side effects. Its always best to talk to your radiation oncologist about the risk of long-term side effects.

Gamma Rays And Cobalt Therapy Systems

Gamma rays are another form of photons used in radiotherapy. Gamma rays are produced spontaneously as certain elements , which release radiation as they decompose, or decay. Each element decays at a specific rate and gives off energy in the form of gamma rays and other particles. X-rays and gamma rays have the same effect on cancer cells.

Many of the original cobalt gamma ray systems have been replaced with linear accelerators. Cobalt systems can not deliver the higher power radiation that is possible with a linear accelerator, and thus may not be as effective at destroying cancerous tumor. Also, the radiation produced by a linear accelerator can be turned on and off, whereas the cobalt system consists of a radioactive source material which is always on.

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During Your Radiation Treatments

Your radiation therapists will bring you to the treatment room and help you lie on the treatment table . Youll be positioned exactly how you were during your simulation and set-up procedure. Your radiation therapists will do everything they can to make sure youre comfortable. Then, theyll leave the room, close the door, and start your treatment.

Figure 2. An example of a radiation treatment machine

Breathe normally during your treatment, but dont move. You wont see or feel the radiation, but you may hear the machine as it moves around you and is turned on and off. Your radiation therapists will be able to see you on a monitor and talk with you through an intercom during your whole treatment. Tell them if youre uncomfortable or need help.

Youll be in the treatment room for 10 to 20 minutes, depending on your treatment plan. Most of this time will be spent putting you in the correct position. The actual treatment only takes a few minutes.

Your radiation treatment wont make you or your clothes radioactive. Its safe for you to be around other people.

How Much Radiation Therapy Costs

Radiation therapy can be expensive. It uses complex machines and involves the services of many health care providers. The exact cost of your radiation therapy depends on the cost of health care where you live, what type of radiation therapy you get, and how many treatments you need.

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for radiation therapy. To learn more, talk with the business office at the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for information on organizations that may help.

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Radiation Therapy Timing And Breast Reconstruction

The timing of radiation treatment in your overall breast cancer treatment plan depends on your individual situation and the characteristics of the breast cancer.

In many cases, radiation therapy is given after surgery. If chemotherapy is planned after surgery, radiation usually follows chemotherapy.

If youre having mastectomy and have decided to have breast reconstruction, its important to know that radiation can cause a reconstructed breast to lose volume and change color, texture, and appearance.

In particular, radiation therapy is known to cause complications with implant reconstruction. Research also suggests that a reconstructed breast may interfere with radiation therapy reaching the area affected by cancer, though this can vary on a case-by-case basis.

For these reasons, some surgeons advise waiting until after radiation and other treatments, such as chemotherapy, are completed before breast reconstruction surgery is done.

Other surgeons may recommend a more staged approach, which places a tissue expander after mastectomy to preserve the shape of the breast during radiation treatments. Once radiation is completed and the tissues have recovered, the expander that was used to maintain the shape of the breast is removed and replaced with tissue from another part of the body or a breast implant.

Immune And Excretory Systems

In the later stages of breast cancer, the tumors have spread to other lymph nodes. The underarms are some of the first affected areas. This is because of how close they are to the breasts. You may feel tenderness and swelling under your arms.

Other lymph nodes can become affected because of the lymphatic system. While this system is usually responsible for transmitting healthy lymph throughout the body, it can also spread cancer tumors.

Tumors may spread through the lymphatic system to the lungs and liver. If the lungs are affected, you might experience:

• chronic cough

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What Emotional Responses Might I Expect

You may or may not experience anxiety or fear when you begin your treatment. Most people tell us that their concerns lessen as they adapt to the new environment and treatment.

Please speak to the staff if you feel that you need either emotional or practical support. There is a social worker on staff in the Radiation Oncology department. This may be a time when you think again about support groups or one-to-one consultation for the feelings that arise or to support your coping. For information about support services, please call the Breast Care Center at 353-7070.