Long-term Side Effects Of Radiation Therapy For Breast Cancer

Side Effects Of Adjuvant Cancer Therapy

Depending on what form of treatment is used, adjuvant therapy can have side effects, like all therapy for neoplasms. Chemotherapy frequently causes vomiting, nausea, alopecia, mucositis, myelosuppression particularly neutropenia, sometimes resulting in . Some chemotherapeutic agents can cause acute myeloid leukaemia, in particular the alkylating agents. Rarely, this risk may outweigh the risk of recurrence of the primary tumor. Depending on the agents used, side effects such as chemotherapy-induced peripheral neuropathy, leukoencephalopathy, bladder damage, constipation or diarrhea, hemorrhage, or post-chemotherapy cognitive impairment. Radiotherapy causes radiation dermatitis and fatigue, and, depending on the area being irradiated, may have other side effects. For instance, radiotherapy to the brain can cause memory loss, headache, alopecia, and radiation necrosis of the brain. If the abdomen or spine is irradiated, nausea, vomiting, diarrhea, and dysphagia can occur. If the pelvis is irradiated, prostatitis, proctitis, dysuria, metritis, diarrhea, and abdominal pain can occur. Adjuvant hormonal therapy for prostate cancer may cause cardiovascular disease, and other, possibly severe, side effects.

If Youre Getting Radiation Therapy To The Breast

If you have radiation to the breast, it can affect your heart or lungs as well causing other side effects.

Short-term side effects

Radiation to the breast can cause:

• Skin irritation, dryness, and color changes
• Breast soreness
• Breast swelling from fluid build-up

To avoid irritating the skin around the breasts, try to go without wearing a bra. If this isnt possible, wear a soft cotton bra without underwires.

If your shoulders feel stiff, ask your cancer care team about exercises to keep your shoulder moving freely.

Breast soreness, color changes, and fluid build-up will most likely go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem, ask your cancer care team what steps you can take. See Lymphedema for more information.

Long-term changes to the breast

Radiation therapy may cause long-term changes in the breast. Your skin may be slightly darker, and pores may be larger and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before treatment. Sometimes the size of your breast changes it may become larger because of fluid build-up or smaller because of scar tissue. These side effects may last long after treatment.

After about a year, you shouldnt have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, tell your cancer care team about them right away.

Less common side effects in nearby areas

Side effects of brachytherapy

Will Radiation Therapy Cause My Hair To Fall Out

Only people who get radiation to the scalp or the brain may have hair loss. Others won’t. If it does happen, itâs usually sudden and comes out in clumps. In most cases, your hair will grow back after therapy stops, but it may be thinner or have a different texture.

Some people choose to cut their hair short before treatment begins to make less weight on the hair shaft. If you lose hair on top of your head, be sure to wear a hat or a scarf to protect your scalp from the sun when you go outside. If you decide to buy a wig, ask the doctor to write a prescription for one and check to see if it’s covered by your insurance or is a tax-deductible expense.

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Radiation Therapy And The Effects On The Heart

• Heart Muscle Damage: When undergoing radiation treatments, there is a very small risk of damage to the heart muscle or the major blood vessels around the heart. This is a potential problem if you have had cancer in your left breast since the heart is on the left side of the chest. Ideally, the heart is either not within the radiation area or only a small amount of the heart will receive any radiation, which helps to lower the risk of significant damage.

• Breathlessness/Dizziness: If your heart has been damaged by radiotherapy you may find that you get tired very easily or get breathless on exertion, like climbing stairs. You may also notice that you sometimes feel dizzy or get chest pains.

Its important to remember that these symptoms can be caused by many things and they arent always a result of damage to the heart. You will want to immediately consult your doctor if you experience any symptoms that may be heart-related.

A promising clinical trial is underway at the Johns Hopkins Avon Foundation Breast Center to determine if The Active Breath Control device will help to better protect women against heart-related side effects. The device provides an innovative way for the patients heart to be spared radiation by controlling her breathing during the actual radiation treatment.

Long Term Side Effects Of Radiotherapy

Depending on the area of the body you have treated, you might have any of these long term side effects after radiotherapy:

• your skin might look darker than it was before in the treated area as if it is suntanned
• your skin in the treatment area will always be slightly more sensitive to the sun
• your skin might feel different to touch
• your hair might grow back a different colour or texture in the treatment area
• you might have permanent hair loss within the treated area
• you might develop red spidery marks on your skin caused by small broken blood vessels
• drainage channels to the arms or legs can become partly blocked resulting in swelling called lymphoedema
• you might be unable to become pregnant or father a child if your ovaries or testicles were in the radiotherapy field

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These Steps Can Help:

• Gently cleanse the treated area using lukewarm water and a mild soap. Donât rub your skin. Pat it dry with a soft towel, or use a hair dryer on a cool setting.
• Donât scratch or rub the treated area. Use only an electric razor if you need to shave there. Donât put on medical tape or bandages.
• Donât apply any ointment, cream, lotion, or powder to the treated area unless your doctor or nurse has prescribed it. This includes cosmetics, shaving lotions, perfumes, and deodorants.
• Choose clothes made from natural fibers like cotton rather than tight-fitting clothing or harsh fabrics like wool or corduroy.
• Avoid extreme heat or cold where you’ve had radiation — no electric heating pads, hot water bottles, or ice packs.
• Also avoid hot tubs and tanning beds.
• Stay out of direct sunlight, especially between the hours of 10 a.m. and 2 p.m., even after you’re done with treatment. The sun can intensify skin reactions and lead to severe sunburn. Choose a sunscreen of SPF 30 or higher. Wear protective clothing, such as a long-sleeved shirt, pants, and a wide-brimmed hat, too.

Restricted Arm And Shoulder Movement

Ways to relieve restricted arm and shoulder movement:

• Many women find relief through gentler exercise modalities like yoga. Yoga allows the practitioner to stretch while learning how to use the breath as both a calming influence and a means to increased flexibility.

• Massage therapy has also proven useful. Discussing the fact youve had radiation therapy and your limited range of motion is very important when you are looking for someone to help you either in terms of exercise or massage. You will want to make sure they are well-versed in helping women overcome these challenges. There are individuals who specialize or have had training specific to these needs.

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Will Side Effects Limit My Activities

Not necessarily, says Yale Medicine radiation oncologist Lynn Wilson, MD, who is the chair of Therapeutic Radiology and a professor of therapeutic radiology at Yale School of Medicine. It will depend on what side effects you experienceand how severe they are. Many patients are able to go to work, keep house, and enjoy leisure activities while they are receiving radiation therapy. Others find that they need more rest than usual and therefore cannot do as much. You should try to do the things you enjoy, as long as you don’t become too tired. Your doctor may suggest that you limit activities that might irritate the area being treated. In most cases, you can have sexual relations if you wish. However, your desire for physical intimacy may be lower because radiation therapy may cause you to feel more tired than usual.

Vitamins To Avoid During Radiation Therapy

Your radiation oncologist may tell you to avoid taking certain antioxidant vitamin supplements, such as vitamins C, A, D, and E, while you’re having radiation therapy. These vitamins might interfere with radiation’s ability to destroy cancer cells. This is because radiation works in part by creating free radicals highly energized molecules that damage cancer cells. Free radicals in the environment can damage all cells, but in the case of radiation treatment they are focused on the cancer cells. Antioxidants help keep free radicals from forming or neutralize them if they do form.

Because of the potential conflict between the goal of radiation therapy and the goal of antioxidants , it makes sense to stop taking any antioxidant supplements during radiation therapy. When radiation is finished, you can resume taking your supplements.

Throughout your treatment, do your best to eat a well-balanced diet that contains all of the vitamins you need. Vitamins that come naturally from food are unlikely to interfere with treatment.

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Advances Of Radiation Therapy

Despite possible long-term side effects of radiation treatment, it’s essential to point out that radiation therapy has come a long since it was introduced in 1903, especially in recent years. With more precise dosing and newer methods of delivery, older studies may overestimate the risks.

At the same time, as people are living longer with cancer, the long-term effects of radiation will become increasingly important. It’s estimated that 50% of people diagnosed with cancer will receive radiation therapy at some point in their journey.

Hair Loss In The Armpit

Radiotherapy to the armpit will make the underarm hair fall out on that side.

Men having radiotherapy will lose the hair on the area of the chest thats being treated.

Hair usually starts to fall out two to three weeks after treatment has started and it may take several months to grow back. For some people, hair lost from radiotherapy may never grow back.

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Accelerated Partial Breast Irradiation

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 . For this reason, some doctors are using accelerated partial breast irradiation in selected women to give larger doses over a shorter time to only one part of the breast compared to the entire breast . 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:

• Intraoperative radiation therapy : In this approach, a single large dose of radiation is given to the area where the tumor was removed in the operating room right after BCS . IORT requires special equipment and is not widely available.

• 3D-conformal radiotherapy : In this technique, the radiation is given with special machines so that it is better aimed at the tumor bed. This spares more of the surrounding normal breast tissue. Treatments are given twice a day for 5 days or daily for 2 weeks.
• Intensity-modulated radiotherapy : IMRT is like 3D-CRT, but it also changes the strength of some of the beams in certain areas. This gets stronger doses to certain parts of the tumor bed and helps lessen damage to nearby normal body tissues.
• Brachytherapy: See brachytherapy below.

What Are The Types Of Radiation Therapy For Breast Cancer

There are different ways to receive radiation therapy. Your healthcare provider will choose the best method based on the cancer location, type and other factors.

Types of radiation therapy for breast cancer include:

• External beam whole-breast irradiation: During external beam whole-breast radiation therapy, a machine called a linear accelerator sends beams of high-energy radiation to the involved breast. Most people get whole-breast radiation five days a week for one to six weeks. The time frame depends on factors including lymph node involvement. In some cases, intensity-modulated radiation therapy may be used.
• External beam partial-breast: This treatment directs radiation to the tumor site only, not the entire breast over 1 to 3 weeks with 3-dimensional conformal radiation or IMRT.
• Brachytherapy: Some people get internal radiation therapy or brachytherapy. Your provider places an applicator or catheter. A radioactive seed is moved into the tumor site. The seeds give off radiation for several minutes before your provider removes them. You receive two treatments every day for five days.
• Intraoperative:Intraoperative radiation therapy takes place in the operating room before your provider closes the surgical site. Your provider delivers a high dose of radiation to the tumor area of the exposed breast tissue.

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Radiation Therapy And Sun Exposure

During radiation treatment, its best to keep the treated area completely out of the sun. This can be especially difficult if youre having radiation therapy in areas or seasons with warmer weather. To help avoid sun exposure:

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  Wear clothing or a bathing suit with a high neckline, or wear a rash guard top.

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  Try to keep the area covered whenever you go outside. An oversized cotton shirt works well and allows air to circulate around the treated area.

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  Avoid chlorine, which is very drying and can make any skin reactions youre having worse. Chlorine is used to disinfect most pools and hot tubs.

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  If you do want to swim in a pool, you might want to spread petroleum jelly on the treated area to keep the chlorine away from your skin.

After your radiation treatment is completed, the treated skin may be more sensitive to the sun than it was in the past, so you might need to take extra protective steps when you go out in the sun:

D Techniques And Imrt

One of the first major advancements in radiotherapy that resulted in reduced doses to normal tissues is the use of 3D imaging for the design of the radiation plan. Radiotherapy based on computed tomography-simulation with treatment planning software and image verification of patient setup allows for more accurate estimation of target and organ dosimetry. 3D planning allows for adjustment of the radiation beam angle and the addition of in field blocks to reduce underlying lung and heart dose. In addition to a static cardiac block, field-in-field techniques have shown the greatest reduction in cardiac dose, but both forward-planning and IMRT have both been employed . These techniques result in lower volumes of heart receiving high and low doses as well as a reduced complication rates. These techniques also minimize dose inhomogeneity that results in areas that receive higher than the prescribed dose within the breast tissue and at the surface of the breast leading to decreased acute skin toxicity.

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Late Complications Of Radiation Therapy For Breast Cancer: Evolution In Techniques And Risk Over Time

Zachary Brownlee1, Rashi Garg1, Matthew Listo1, Peter Zavitsanos1, David E. Wazer1,2, Kathryn E. Huber1

1Department of Radiation Oncology, Tufts Medical Center and Tufts University School of Medicine , Rhode Island Hospital and Brown University School of Medicine , , USA

Contributions: Conception and design: DE Wazer, KE Huber Administrative support: KE Huber Provision of study materials or patients: None Collection and assembly of data: None Data analysis and interpretation: None Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Abstract: Radiation therapy in combination with surgery, chemotherapy, and endocrine therapy as indicated, has led to excellent local and distant control of early stage breast cancers. With the majority of these patients surviving long term, mitigating the probability and severity of late toxicities is vital. Radiation to the breast, with or without additional fields for nodal coverage, has the potential to negatively impact long term cosmetic outcome of the treated breast as well as cause rare, but severe, complications due to incidental dosage to the heart, lungs and contralateral breast. The long-term clinical side-effects of breast radiation have been studied extensively. This review aims to discuss the risk of developing late complications following breast radiation and how modern techniques can be used to diminish these risks.

Keywords: Radiation breast cancer late toxicity

Will My Appetite Be Affected

Many side effects can cause problems with eating and digesting food, but you always should try to eat enough to help damaged tissues rebuild themselves. It’s very important not to lose weight during radiation therapy so that your body can heal. Try to eat small meals often and eat a variety of different foods. Your doctor or nurse can tell you whether your treatment calls for a special diet and a dietitian will have a lot of ideas to help you maintain your weight.

If you have pain when you chew and swallow, your doctor may advise you to use a powdered or liquid diet supplement. Many of these products, available at the drugstore without prescription, are made in a variety of flavors. They are tasty when used alone, or they can be combined with other foods, such as pureed fruit, or added to milkshakes. Some of the companies that make diet supplements have produced recipe booklets to help you increase your nutrient intake. Ask your dietitian or pharmacist for further information.

What side effects occur with radiation therapy to the head and neck area? Some people who are having radiation to the head and neck have redness and irritation in the mouth, a dry mouth, difficulty in swallowing, changes in taste or nausea. Try not to let these symptoms keep you from eating.

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