Radiation therapy for breast cancer

Overview:

Radiation therapy (RT) is a treatment done for cancers of the breast. It uses high-energy radiation in the form of X-rays or protons to destroy the cancerous cells of the breast. These are invisible rays and do not cause pain as they pass through the breast. RT for breast can be done in combination with surgery or chemotherapy. RT kills the genetic material of the cancerous cells of the breast. This kills the cancerous cells making it difficult for them to replicate while sparing the healthy breast tissue. 

Types of RT to breast cancer. 

RT for breast cancer can be given as external beam RT (EBRT) or internal beam RT. In EBRT, high-energy radiation is sent to the breast using a machine called the linear accelerator. This is delivered as intensity-modulated RT or stereotactic RT. In Internal beam RT, seed implants are placed in the tissue to deliver the radiation, or the target area is exposed to a high beam of radiation. This is called the brachytherapy. Sometimes RT is also used intraoperatively. Breast cancer tissue is first removed by surgery and then radiotherapy is used to treat the remaining tissue. 

Indications

• RT for breast cancer is used to kill the tumour cells. 
• It is used after surgery to remove the cancer tissue. 
• It is also used as a symptomatic treatment to provide relief from the symptoms of advanced breast cancer. 
• It can be used along with chemotherapy. 
• RT for breast cancer can also be used for those that cannot be removed with surgery. 
• In certain aggressive cancers of the breast like inflammatory breast cancers, a combination of chemotherapy and surgery followed by RT are used. 
• RT is also used to treat cancers that have spread to other parts of the body called metastatic cancers. This helps to shrink the cancers and relieve the pain. 

Before the procedure:

Before undergoing RT, a healthcare professional will review the medical and surgical history along with a physical examination. Based on the fitness an individual is taken for RT. It is advisable to discuss with the HCP the necessity of the RT before undergoing the treatment. 

Before the RT, an individual will undergo radiation simulation. Simulation is the process where the HCPs determine the most comfortable position to receive the radiation by avoiding exposure to the adjacent healthy tissues. An individual is made to lie on the table and using some restraints or immobilizing devices, the best comfortable position to receive the RT will be determined. The area on the body to receive the treatment will be marked using temporary or permanent markers. 

Advanced imaging like the MRI or CT will determine the extent, size, and shape of the tumors and the area of the skin to be treated. Then they calculate the dosage and determine the direction of the beam to the target area. Sometimes tight-fitting masks may be customized to prevent radiation exposure to the vital organs of the body. RT planning helps to get the exact dose and correct radiation beams at the target site without harming the adjacent healthy tissue. RT is generally planned 3-4 weeks after chemotherapy or 3-8 weeks after surgery and is done as an outpatient procedure. 

During the procedure:

An individual will undergo RT for five days in a row, in a week for 5-6 weeks, with each session lasting about 10-30 minutes. The number of days and dosage will be determined based on the tumor's extent and the treatment response. An individual is placed on the table based on the previous markings to administer RT. 

The individual's position on the table is confirmed using an X-ray, a CT scan, or a laser to deliver the RT at the same location as planned. The HCP team will be in a console room from which they will be viewing as the RT goes on. 

RT is administered in the form of X-rays or proton therapy. If an EBRT is planned, the beam of radiation is directed to the exact locations of the tumor using a linear accelerator machine. If it is in the form of brachytherapy it is inserted in the tumor location either as seeds or through a tube using a high dose of radiation. 

RT for breast cancer can be given after Lumpectomy or Mastectomy. Lumpectomy with RT is also known as a breast-conserving surgery. In this, only the area of the cancerous tissue is removed by conserving the remaining part of the breast. After lumpectomy RT can be given to the entire breast (whole breast irradiation) using EBRT or only to a part of the breast called partial-breast irradiation. 

RT after mastectomy is decided based on various factors like the spread of the cancerous tissue to the lymph glands present in the underarm area, the size of the tumour, or positive tissue margins after surgery. RT after mastectomy kills any of the remaining cancerous cells. 

After the procedure: 

The entire procedure of RT takes a few minutes but the preparation for the PT takes about 30-45 minutes. After the treatment, an individual is subjected to multiple CT or MRI scans to analyse the response of the tumour to the treatment. One can continue their daily activities after the RT. 

Risks, Side effects, and complications:

Side effects of RT differ based on the type of treatment and the tissues treated. Fatigue, redness in the treated area, peeling of the skin, and blister formations are some of the common side effects. The other complications include swelling of the breast, and arm, fractures of the ribs, and secondary cancers. 

Conclusion: 

Radiotherapy for breast cancer is a vital treatment procedure to treat breast cancers. This can be used along with surgery or chemotherapy. This kills the cancerous tissues of the breast. RT helps to decrease the risk of recurrence of the cancer and increases the chance of survival. 

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