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Treatment of Breast Cancer
Overview of Treatment Options for Breast Cancer
Radiation therapy may also be used to treat areas of metastatic disease (such as lung, liver, brain or bone) for palliation (relief of symptoms) such as pain.
In general, there are two major types of radiation therapy:
- External beam radiation - the source of the radiation comes from outside the body and is produced by a special machine
- Brachytherapy - a radiactive source is placed inside the body
External Beam Radiation Therapy
External beam radiation treatments are generally given five days a week for about six to eight weeks on an outpatient basis. The initial appointment may take up to 2 hours to allow for treatment planning and placement of markings where the radiation beam is to be directed. After that, each treatment appointment takes about 15 minutes.
Whole Breast Irradiation - This is the standard approach for radiation therapy for breast cancer. Additional "Boost Irradiation" doses may be administered to the tumor site ("bed") to reduce the risk of local recurrence after surgery, such as lumpectomy.
Electron Intraperative Therapy (ELIOT) is the application of high dose radiation during surgery following removal of the tumor. Advantages to this approach include the fact that it does not irradiate the skin and other breast, and radiation exposure to the lungs and heart is greatly reduced.
Brachytherapy
Brachytherapy, also known as internal or interstitial radiation, is another way to deliver radiation therapy. Radioactive "seeds" are placed directly into the breast tissue next to the cancer. Often this is used to add an extra "boost" of radiation to the tumor site. This method is also being studied in clinical trials as the only source of radiation for women who have had lumpectomy. This is not yet considered a standard treatment, but studies thus far have been promising.
Mammosite is a method of brachytherapy where a balloon that is attached to a thin tube is inserted into the lumpectomy space and is filled with saline solution. Radioactive material is inserted through the tube into the balloon for a brief time and is then removed. This is done twice daily for 5 days. Once treatment is completed, the balloon is deflated and removed.
Partial Breast Irradiation is a new, experimental approach which may be administered via external beam or brachytherapy. It allows treatment over a much shorter period of time (5 days total) and to only the part of the breast with the cancer. It is hoped that partial breast irradiation will prove to be equal to the current, standard whole breast irradiation. However, this technique is still experimental.
Side Effects of Radiation Therapy
The main side effects of external beam radiation therapy are swelling and heaviness in the breast, sunburn-like skin changes in the treated area, and fatigue. These changes to the breast tissue and skin usually abate in 6 to 12 months. There may also be some aching in the breast and, rarely, a rib fracture due to weakening of the bone.
Radiation therapy of axillary lymph nodes can cause lymphedema (swelling of the arm on the affected side). A rare complication is the development of another cancer called angiosarcoma. It is treated with mastectomy but can be life-threatening.
