Radiation Therapy and Breast Cancer

The Breast Center Smilow Cancer Hospital 20 York Street, North Pavilion New Haven, CT 06510 Phone: (203) 200-2328 Fax: (203) 200-2075

RADIATION THERAPY

Radiation therapy is a local treatment using high energy rays (like x-rays) to kill cancer cells or shrink tumors. It has an important role in treating all stages of breast cancer because it is so effective and safe. Radiation therapy can be used to kill any cancer cells that remain in the breast, on the chest wall or in the under arm area particularly after breast conserving treatment. Nearly all patients who undergo a partial mastectomy as their primary surgical treatment will require evaluation by the radiation oncologists. They are the cancer doctors who prescribe radiation and oversee your radiation treatment. Radiation therapy after surgery has been shown to statistically significantly decrease the risk of a local, or in breast, recurrence. Research has now shown that selected women over the age of 70 may sometimes safely skip this treatment, but the decision is usually made in consultation with the radiation oncologist.

Radiation may NOT be a good choice for you if: • you have previously been radiated in that same area • you have a connective tissue disease such as scleroderma or lupus • you are pregnant • you are not willing or able to commit to the daily schedule it requires

Radiation therapy may be required after mastectomy if there are features associated with a high risk of recurrence. These may include: • a cancer 5 cm or larger • the presence of lymphovascular invasion • evidence of lymph node involvement • skin involvement • a positive margin or invasion into the chest wall

There are currently two types of radiation treatments. Whole Breast External Beam radiation is the most common type of radiation treatment. Your radiation oncologist may also recommend treatment to the nearby lymph nodes in some circumstances. Partial Breast radiation offers another method of treatment. PBI, or Partial Breast Irradiation is offered by way of a Clinical Trial, and is only appropriate for selected patients.

Revised December 2017 After surgery for breast cancer, almost every woman choosing breast conserving surgery will attend both a Medical Oncology and Radiation Oncology consult visit appointment. If chemotherapy is not needed, radiation treatments usually start three to six weeks after surgery. If the Medical Oncologist recommends an Oncotype (see details in Medical Oncology section), the results take 3 weeks to return and the team will wait for this information to start radiation. It is safe and expected that the team will wait the three weeks for this information before making final plans for radiation.

External Beam Radiation Treatment (EBRT) is given five days a week (Monday through Friday) for four to six weeks. Each treatment lasts only a few minutes and is completely painless. It is like getting a regular x-ray, but for a longer time. The main side effects of EBRT include swelling and heaviness in the breast, sunburn like changes to the skin of the breast, and fatigue. Long-term changes to the breast can include a change in the texture of the tissue, some mild chronic soreness, and occasional decrease in the size of the breast.

Partial Breast Irradiation (PBI) is a type of external beam radiation therapy where only part of the breast receives external beam radiation, and is given twice a day for 5 days. It often involves a preoperative Radiation Therapy consultation. Your surgeon will place markers, called “fiducial markers” at the time of surgery or may opt to place them during a postoperative visit in the office. These markers are used by the radiation team to plan the radiation.

Once the radiation is completed, the normal tissues will heal and get back to normal. You will probably have received as much radiation as these cells can safely handle and therefore it is not possible to treat this same area again with another dose of radiation. If the cancer returns to the same breast, usually a mastectomy will be required. If a cancer should occur elsewhere in your body (including the other breast) radiation can be safely used again.

Revised December 2017