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Breast cancer

Radiation therapy for breast cancer

When a breast tumor is large or not easily removed by surgery, radiation therapy before surgery may help to shrink the breast tumor. After breast-sparing surgery, radiation treatments may help destroy remaining breast cancer cells.

Radiation therapies for breast cancer include:

Accelerated partial breast irradiation (APBI): This breast radiation therapy delivers focused radiation specifically to the part of the breast where the tumor was removed.

Some advantages of APBI for breast cancer may include:

AccuBoost®: This breast-conservation therapy delivers a targeted dose of radiation directly to the tissue surrounding the tumor bed. Potential advantages of AccuBoost for breast cancer include:

Calypso® 4D Localization System™: This technology allows radiation oncologists to deliver focused doses of radiation with greater precision for breast cancer patients.

Before treatment, transponders are placed on the skin near the middle of the patient’s chest to track respiratory movement and other patient motion. Patients are then asked to take a deep breath and hold it for a few seconds. This action expands the chest and moves the heart out of the radiotherapy beam's path. The radiation oncologist uses this “map” to deliver the prescribed radiotherapy. The technology allows for continuous monitoring during treatment and will discontinue the delivery of radiation if the patient’s breathing pattern falls outside the “mapped” treatment plan.

In the recent generation of the Calypso system, the transponders are able to show the position of the patient’s treatment target area, and automatically shut the beam off in the event of a cough, sneeze or other internal change of position that moves the treatment target area out of the X-ray beam’s path. By precise targeting and tracking and by avoiding nearby healthy tissues, Calypso is designed to reduce radiation exposure to the heart, lungs and other healthy tissues.

External beam radiation therapy (EBRT): The most common type of radiation therapy for breast cancer, EBRT is usually given about a month after surgery, to give surgical wounds time to heal. It may also be used in combination with chemotherapy and may be delayed until chemotherapy is complete.

In EBRT, a beam of radiation, similar to but stronger than an X-ray, is focused on the spot where the cancer was removed. If a lumpectomy was performed, a patient may receive EBRT to the entire breast, a technique called whole-breast radiation. EBRT may also be delivered to nearby lymph nodes.

Some advantages of EBRT for breast cancer patients may include:

High-dose rate (HDR) brachytherapy: This type of internal radiation therapy delivers radiation from implants placed close to, or inside, the tumor(s) in the body.

Advantages of HDR brachytherapy for breast cancer may include:

Hyperthermia: Hyperthermia (meaning elevated temperature) destroys cancer cells by raising the tumor temperature to a “high fever” range, similar to the way the body uses fever naturally when combating other conditions.

Breast cancer hyperthermia helps make breast cancer cells more vulnerable to the effects of other treatments, like breast cancer radiation therapy and certain chemotherapy drugs.

Radiation oncologists typically use hyperthermia to treat superficial breast tumors located within a few centimeters from the surface of the body.

Intensity modulated radiation therapy (IMRT): Advanced software plans a precise dose of radiation, based on tumor size, shape and location. A computer-controlled device called a linear accelerator delivers radiation in sculpted doses that match the 3-D geometrical shape of the tumor, including concave and complex shapes.

Advantages of IMRT for breast cancer may include:

IMRT breast cancer radiation therapy may be used in conjunction with other treatments. It may be an appropriate option for those who have previously had breast cancer radiation therapy and are experiencing recurrent tumors in the treated area.

Intraoperative radiation therapy (IORT): IORT delivers a concentrated dose of radiation therapy to a tumor bed during surgery. This technology may help kill microscopic disease, reduce radiation treatment times or provide an added radiation "boost."

IORT is performed immediately following the removal of a breast lump and before the lumpectomy incision is closed. A large dose of radiation is focused directly on the surgery site.

A patient must be a surgical candidate in order to be eligible for breast cancer IORT. This treatment is generally reserved for patients with early-stage disease.

MammoSite® Radiation Therapy System (RTS): A form of brachytherapy targeted specifically for breast cancer treatment, MammoSite RTS uses a catheter to place radioactive pellets (seeds) directly in the area where a breast tumor has been surgically removed via lumpectomy.

Advantages of MammoSite RTS for breast cancer may include:

TomoTherapy®: This technology combines a form of intensity modulated radiation therapy (IMRT) with the accuracy of computed tomography (CT) scanning technology, in one machine.

Advantages of TomoTherapy for breast cancer may include:

If you have advanced-stage or recurrent cancer and are no longer able to receive traditional radiation, TomoTherapy may be a breast cancer treatment option. TomoTherapy may also be an option for breast cancer patients who have reached their maximum tolerated dose of traditional radiation. This therapy can re-treat previously radiated areas with high doses of radiation and with pinpoint accuracy.

Trilogy®: This radiation therapy system provides intensity modulated radiation therapy (IMRT), image guided radiation therapy (IGRT), stereotactic radiosurgery (SRS) and fractionated stereotactic radiation therapy—all from one machine.

With Trilogy, radiation oncologists deliver sculpted radiation beams to breast tumors, while protecting the surrounding healthy breast tissue and reducing your time on the treatment table.

TrueBeam®: This software and respiratory tracking system enables us to confirm the location of the breast tumor, track its movement and help avoid damage to healthy surrounding tissue.

A tumor in the breast can move as you breathe, making it difficult to target it accurately with standard radiation. As a result, the tumor may not receive enough radiation and healthy tissue near the tumor may be damaged.

Side effects of radiation therapy for breast cancer

Radiation therapy for breast cancer may cause short-term or long-term side effects. Short term side effects of internal or external beam radiation include:

Patients, especially those who had radiation therapy at a young age, are at higher risk for developing a second cancer later in life. Other long-term side effects of radiation for breast cancer include:

At Cancer Treatment Centers of America® (CTCA), our cancer experts use sophisticated tools and technology designed to limit the exposure of healthy tissue to radiation. One such tool is the Access Prone 360™ Board. This specially designed board was developed to help spare healthy tissue in vital organs from unnecessary radiation exposure. The board—a modified version of the table patients lie on while receiving radiation treatments—has an open space for the patient’s left breast. When the patient is lying face down, the breast naturally hangs through the opening and away from the body. The radiation beams then have a clear path to the breast without affecting the heart or lungs. This may also benefit early-stage breast cancer patients, by exposing only part of the breast to radiation while avoiding tissue in other areas of the breast—and the organs behind it.

Next topic: How is breast cancer treated with surgery?