Advances in breast cancer radiation therapy have benefited patients

Advances in breast cancer radiation therapy have benefited patients

When I was diagnosed with breast cancer 26 years ago, I had surgery to remove the cancerous area, followed by six weeks of daily radiation treatments. It was a bit onerous driving back and forth to the hospital daily to receive treatment, and by the third week I was very fatigued and had bright red areas on my breast that burned and were uncomfortable.

While I am grateful for the treatments that helped save my life and reduced the risk of breast cancer recurrence, it is reassuring to know that advances in radiation therapy have made treatment more manageable and less disruptive to everyday life.

"Breast cancer treatment has changed pretty significantly over the past 20 years," said Jeffrey Martin, MD, a radiation oncologist at Davenport-Mugar Cancer Center - Radiation Oncology at Cape Cod Hospital. "It used to be everyone got six weeks of radiation treatment. Nowadays, it is common for patients to get treated over three to four weeks resulting in fewer trips back and forth to the hospital and less skin toxicity."

What is radiation therapy?

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. It is an outpatient treatment that is administered over a number of weeks.

Treatments can be delivered either by external beam from a machine that targets radiation to the area of cancer, or internal radiation with the source of radiation placed inside your body near the cancer.

Types of Radiation Therapy

There are two types of external beam radiation that are currently used, said Dr. Martin:

• 3DCRT (three-dimensional conformal external beam radiation therapy): Delivers a fixed dose of radiation from different angles and different directions to a specific area.
• IMRT (intensity-modulated radiation therapy): A more sophisticated method of calculating how much radiation to give from each angle allowing higher doses of radiation to be given in the areas that need more treatment and less to areas that are closest to sensitive organs or tissues.

Planning the Radiation Treatments

When planning radiation treatment, care teams consider several things.

"A lot of it depends on a few factors," said Dr. Martin. "It depends on their tumor, the extent of the tumor, the patient's anatomy, breast size and shape and location of the tumor. All this information goes into the shared decision-making process with the patient. We will discuss a couple of different options for treatment and if they would be a good candidate for either of them. Sometimes, if a patient is a borderline candidate for one or the other, I will talk about the pros and cons of each approach."

Options for Breast Radiation Therapy

The options for treatment with partial breast and full breast radiation, according to Dr. Martin are:

• Partial breast radiation: For some women with early-stage breast cancer, a shorter and more targeted form of radiation called accelerated partial breast irradiation (APBI) can be an option. It is generally considered for women age 50 and older who have favorable tumors that are small-less than two centimeters-estrogen receptor-positive, usually grade one or two, confined to the breast with no cancer in the lymph nodes, and have negative surgical margins, (no cancer found in the outer edges of the tumor).

APBI focuses radiation on the area where the tumor was removed. Larger doses are given over a shorter period, limiting the amount of healthy breast tissue exposed to radiation and potentially reducing side effects. Patients may be able to complete treatment in as few as five radiation sessions.

• Whole breast radiation: Women who have tumors like lobular carcinoma (cancer that begins in the milk-producing glands) or lobules or if they have a more aggressive ductal carcinoma in situ (cancer that forms in the lining of the milk ducts and spreads to outside breast tissue) will need a longer duration will radiation treatments to their entire breast over three to four weeks. If they have had a mastectomy, the radiation will also focus on the chest wall and if the cancer had spread to the lymph nodes, those areas would be irradiated as well.

Notable Changes

In addition to shorter duration of treatments, there have been changes in the techniques to treat left-side breast cancer.

With a goal of reducing the later effects on the heart that can sometimes occur with more radiation, the patient is instructed to hold their breath as their treatment gets delivered, Dr. Martin said. It helps to inflate their lung and push their heart down and away from their breast. Using IMRT with the breath-hold technique, it will help reduce effects on the heart. Patients who have larger breasts can receive radiation treatment in the prone position (lying on their stomach) so their breast can be positioned away from the chest wall and helps the radiation stay off the heart and lung area.

"I think the most impressive change I have seen is how well people do with radiation now, especially with partial breast radiation," said Dr. Martin. "Patients go through the treatments without having a lot of side effects and when we see them back in follow-up, they have very little pinkness of their skin, and they often comment that the treatment wasn't bad. To see and hear how well they are doing has been very rewarding."