Radiation therapy uses high-energy rays or particles thereof to destroy malignant cells. Radiation therapy in breast cancer is assigned:
- After surgery or chemotherapy to eliminate the remaining pathological segments in the body and reduce the likelihood of the return of the disease.
- In conjunction with other therapy for stage III disease.
- For the treatment of relapse in the area of the mastectomy.
- For pain relief or control of symptoms of advanced cancer - as palliative therapy.
Radiation dose, mode is determined individually for each situation.
The disease is treated, including, by external radiotherapy. Upgraded accelerators to direct the flow of irradiation of malignant tumors and its surrounding tissues.
Irradiation of breast cancer after the operation organosberegajushchih (lumpectomy)
Almost always performed after lumpectomy radiotherapy. According to the results of research, this type of treatment after surgery reduces the organ-pathology likely return. The entire breast, skin and chest wall may have lymph nodes are irradiated.
It is carried out once a day, five days a week for a month - half.
- Duration of therapy is due to the number of fractions and the total radiation dose.
- A number of treatment centers provide a conducting radiation therapy for breast cancer for more than a short time (eg, within 3 weeks), including Assuta Hospital.
Sometimes an additional dose (higher - high-dose chemotherapy) is given in the zone where it was resected malignant tumor, to further reduce the likelihood of a return of the disease. The so-called «boost-therapy" prescribed:
- If abnormal cells are found in the resection area, or have contraindications for surgery.
- After radiation therapy for breast cancer have a high risk of local recurrence (disease returned in place of the original hearth): aggressive tumors; tumors larger than five centimeters in diameter; malignant lesions, located close to the chest wall muscles.
cancer breast irradiation after radical intervention
Following mastectomy can irradiate the chest wall and lymph nodes with a high probability of returning disease:
- If the cancer has hit 4 or more lymph nodes in the armpit.
- Neoplasm has a size in diameter of more than five centimeters.
- There are secondary lesions in the chest wall or skin.
Runtime radiotherapy of breast cancer
In the process of the lumpectomy can intraoperative radiation therapy when bed after rezetsirovaniya neoplasm is irradiated once, using a high dose.
There are no clear recommendations on the time of this therapy after surgery, it is customary irradiation in breast cancer begin after 8-12 weeks after surgery.
Sometimes chemotherapy and irradiation is carried out together. Basically radiotherapy followed by treatment with cytostatics. This is due to heavy potential negative effects of multi-purpose, especially with regard to:
- anthracyclines such as doxorubicin (Adriamycin);
- taxanes - paclitaxel (Taxol).
When radiation therapy is not used in breast cancer?
Impossible to carry out this type of treatment in connection with certain medical conditions:
- Diseases that increase the chance of unwanted effects of therapy - systemic lupus erythematosus, scleroderma.
- Lung problems - reducing the volume of organs and tuberculosis.
- The damaged heart muscle (cardiomyopathy).
- Previous radiotherapy to the chest area.
Types of external radiation for breast cancer :
- Express gipofraktsionnaya or radiotherapy administered in high doses in smaller quantities procedures, instead of 5 weeks through 3. Research results confirmed that of reducing recurrence after lumpectomy, and that with a standard treatment.
- 3D-conformal radiotherapy involves the maximum approximation of the radiation form to form a tumor, minimizing damage to surrounding tissue and reduces the number of complications. Currently, not enough of the results of this treatment after many years, so, according to some doctors, rapid methods are experimental.
HDR brachytherapy (internal radiation breast cancer)
This type of treatment involves the placement of radioactive pellets or grains in the breast tissue, providing a high dose of radiation from implants that have on or inside the tumor. Irradiation is focused on the affected area, giving it a maximum dose and minimizing exposure to surrounding healthy tissue.
It is used:
- After lumpectomy in combination with external beam radiation therapy. Depending on the type and stage combined with other therapies.
- As an independent method of exposure.
Types of brachytherapy:
- Interstitial brachytherapy - a technique whereby a resected tumor bed via small catheters, radioactive seeds are administered for a short time each day, and then remove them. It ensures accurate processing, which takes only a few minutes. For some patients, interstitial brachytherapy - a faster and more effective treatment.
- Intracavitary brachytherapy is the more common type. Various types of devices: SAVI ®, Contura ®, Axxent ®, MammoSite ®. Inside the breast, on the left of the resected tumor bed, implanted balloon catheter with a small size. Twice daily for five days administered radioactive pellets at a certain time, then they are removed.
Potential adverse effects of radiation therapy for breast cancer occur in varying degrees in different patients. They are largely due to the size of the treated area, the total dose and regimen.
It is necessary to report on emerging symptoms medical team in clinic Assuta, which the patient works. Since many of them can be eliminated through medication and changes in diet and other measures. Experts estimate the severity, making adjustments to the treatment process.
In connection with the probability of some adverse effects is not recommended to wear a bra in the course of radiation therapy for breast cancer , in extreme cases, soft, comfortable and pitted.
This is one of the most common side effects. It can be triggered by the accumulation of toxic substances in the body in connection with the death of cancer cells, depression, poor appetite, anemia. During irradiation the body uses more energy for self-healing, so fatigue and weakness is not always possible to escape through the rest.
This symptom usually occurs at the second week of therapy or later, can be increased and the increase in its holding. As a rule, after the end of treatment fatigue passes, for some people it is observed even for a few weeks or months after graduation.
Changes appear on the skin due to the fact that external beam radiation therapy directs radiation through the skin to the pathological focus. Potential reactions include:
- redness or darker brown shade;
- pain in the nipple and folds under the breasts;
- red marks on the small ruptured blood vessels (telangiectasia).
Most of them occur during the first two weeks after radiation therapy for breast cancer, held a few weeks after its completion. Certain changes, such as darkening of the skin, telangiectasia, or scars may remain. For some women, there are no skin reactions associated with irradiation.
Breast Cancer Radiation therapy can cause a number of different changes in the breast areas undergoing treatment:
- Changes in breast size, shape or elasticity. Swelling may persist for up to 6 months in the treatment when radiotherapy is carried out after the lumpectomy.
- Increase or decrease in sensitivity in the processing zone.
- Soreness, heaviness, discomfort.
A woman should inform your doctor about any current changes that occur after a while: it concerns the size, shape and appearance of the breast.
Pain in the chest
In some cases there is discomfort and pain after irradiation. This symptom may persist for six months or more after treatment.
Radiotherapy can cause pain and inflammation of the pharynx and esophagus tissue, causing difficulty in swallowing. This is an unintended consequence of treatment usually occurs 2-3 weeks after the start and held when exposure ends and the inflammation is reduced.
After radiotherapy for some women marked difficulties in shoulder movements in connection with recent changes in the muscles. This type of treatment in the processing leads to the density and stiffness of the muscles due to the formation of scar tissue. Benefit Child exercises aimed at rehabilitation.
Rarely observed nausea, to cope with which help the drug. Disappears after irradiation.
Radiation pneumonitis - unusual adverse effects of treatment, which appears after weeks or months following radiation therapy for breast cancer. It often occurs in women who receive methotrexate and 5-fluorouracil (Adrucil, 5-FU) at the same time as radiotherapy.
One potential side effect is damage to the nerves in the shoulder area. As a result, marked numbness, burning or tingling in the arm or shoulder. This unintended consequence of therapy is rare, but long-term gains for some women.
damage to heart
If at the same time carried out a comprehensive treatment with radiation and chemotherapy on the left side of the chest, there is a likelihood of damage to the heart muscle. This is a rare and long-term side effects.
Be sure to inform the team of doctors with which the patient is working, the presence of shortness of breath, swelling of hands or feet, chest pain. Carried out continuous monitoring of heart function in the presence of any injury or damage to the body. Used drugs and other therapies, diagnostic tests are carried out constant when a violation.
Occasionally radiotherapy can damage bone ribs cells that will cause fractures.
Another type of cancer
The probability of developing a second malignancy is low enough. This can be angiosarcoma of the breast, lung, and skin cancer.