Breast Cancer Radiation Therapy
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Breast Cancer Radiation Therapy
Breast Cancer
Radiation Therapy
Radiation therapy is a common and effective treatment modality for breast cancer. It involves the use of high-energy X-rays or other particles to target and destroy cancer cells or inhibit their ability to grow and divide. The decision to include radiation in the treatment plan for breast cancer depends on several factors, including the type and stage of the cancer, the characteristics of the tumor, the type of surgery performed, and individual patient considerations. Radiation is typically delivered in multiple sessions (fractions) over several weeks. This approach helps minimize damage to surrounding healthy tissues.
Here are common situations in which radiation therapy is used for breast cancer:
After Breast-Conserving Surgery (Lumpectomy)
radiation therapy is typically recommended after breast-conserving surgery to reduce the risk of local recurrence. The radiation helps to eliminate any remaining cancer cells in the breast tissue surrounding the tumor bed.
Post-Mastectomy Radiation
the use of radiation therapy after mastectomy may be recommended in certain cases. This decision is influenced by factors such as the size of the tumor, involvement of lymph nodes, and other high-risk features. The objective is to reducethe risk of recurrence in the chest wall and surrounding tissues.
Positive Margins After Surgery
if surgical margins are positive (cancer cells are found at the edge of the removed tissue), additional surgery or radiation therapy may be recommended to achieve clear margins to ensure that any residual cancer cells are targeted to reduce the risk of local recurrence.
Neoadjuvant Radiation
This involves giving radiation therapy prior to surgery (neoadjuvant) to shrink tumors in situations where a lumpectomy might otherwise result in positive margins. The goal is to reduce the size of the tumor and make breast-conserving surgery more feasible.
Axillary Lymph Node Involvement
if cancer is found in the axillary lymph nodes, radiation therapy may be recommended to the chest wall and regional lymph nodes to target areas at higher risk of containing residual cancer cells after surgery.
Inflammatory Breast Cancer
radiation therapy is commonly used as part of the multimodal treatment for inflammatory breast cancer to address the extensive involvement of the breast and surrounding tissues.
Following Breast Reconstruction
if breast reconstruction is performed after mastectomy, radiation therapy may still be recommended in certain cases with the goal of reducing the risk of recurrence in the reconstructed breast and surrounding tissues.
In Certain High-Risk Scenarios
in some high-risk situations, even after mastectomy, radiation therapy may be considered for cases with large tumors, involvement of multiple lymph nodes, or certain adverse tumor feature to reduce the risk of recurrence in the chest wall and regional lymph nodes.
Indications for radiation therapy:
- Postoperative (Adjuvant) Radiation – the use of radiation following surgery to treat residual cancer cells not removed during surgery is called adjuvant therapy. Radiation is often administered after breast-conserving surgery (lumpectomy) to reduce the risk of local recurrence. It’s often combined with systemic therapies (chemotherapy, hormone therapy).
- Post-mastectomy Radiation – administered after mastectomy if there is a high risk of recurrence, particularly if cancer involves multiple lymph nodes or if the tumor is large.
- Neoadjuvant Radiation – given before surgery to shrink tumors, especially when a lumpectomy might otherwise result in positive margins.
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Types of radiation therapy:
- External Beam Radiation – this is the most common type of radiation therapy for breast cancer. It involves delivering radiation from outside the body to the targeted area. There are different types of external beam radiation techniques used for breast cancer treatment, each with its own advantages and considerations. Main types:
- 3D Conformal Radiation Therapy (3DCRT) – this technique uses three-dimensional imaging to precisely target the shape and size of the tumor. It provides better accuracy in delivering radiation to the tumor while minimizing exposure to surrounding healthy tissues.
- Intensity-Modulated Radiation Therapy (IMRT) – IMRT is an advanced form of 3D conformal radiation that modulates the intensity of the radiation beams. It enables the precise control of the intensity of each radiation beam, enabling better customization to the shape of the tumor and minimizing radiation exposure to nearby normal tissues. This can be particularly useful in treating complex breast anatomy.
- Volumetric Modulated Arc Therapy (VMAT) – VMAT is an extension of IMRT that delivers radiation in an arc around the breast. It enhances treatment efficiency by continuously adjusting the radiation dose during the rotation of the treatment machine, shortening treatment times while maintaining precision.
- Tomotherapy – a form of IMRT that combines intensity modulation with a helical delivery technique that provides continuous delivery of radiation from all angles around the patient, allowing for highly conformal treatment while minimizing exposure to healthy tissues.
- Image-Guided Radiation Therapy (IGRT) – IGRT uses imaging techniques (such as CT scans) to guide the delivery of radiation with a high degree of precision and enables real-time adjustments to the treatment plan based on daily imaging, ensuring accurate targeting of the tumor.
- Stereotactic Body Radiation Therapy (SBRT) – SBRT delivers highly focused, precise, and high-dose radiation in a few treatment sessions and is suitable for certain cases where the tumor is small, well-defined, and localized. It is not commonly used for standard breast cancer treatment but may be considered for specific situations.
- Internal Radiation (Brachytherapy) – brachytherapy is a treatment where radioactive material placed inside a seed, pellet, wire, or capsule is implanted in or near the tumor using a needle or catheter inserted into a blood vessel. The radiation damages the DNA of nearby cancer cells. This form of radiation is less commonly used for breast cancer but may be an option in certain cases.
Optimizing delivery of radiation therapy for breast cancer
Individualization of radiation therapy for the treatment of breast cancer is important with the goal of maximizing the therapeutic effect on the tumor while minimizing the impact on surrounding healthy tissues. 3-D CT-based treatment planning should routinely be utilized to delineate target volumes & organs at risk and assess dose distribution across the entire treatment volume. Treatment planning should be optimized to maximally improve homogeneity across the target volume while minimizing dose to organs at risk. Techniques such as respiratory control (deep inspiration breath-hold), prone positioning, and cardiac blocks may also be used to reduce radiation doses to the heart, lungs, and adjacent normal tissue.
