What should I know about radiation if I have breast cancer?

What should I know about radiation if I have breast cancer?

By Astrid D. Morris, MD
Radiation Oncologist

If you’ve been diagnosed with breast cancer, you may wonder if radiation is an option for you.

Radiation is an important pillar of treatment for breast cancer and has never been safer when designed by an experienced team with state of the art technology. Radiation will be part of a standard treatment plan after breast conserving surgery (also called lumpectomy or partial mastectomy). With the addition of radiation to the breast as an insurance policy, patients will do just as well as those undergoing mastectomy. Even after a mastectomy there are indications when radiation to the chest wall and nodes are recommended for best outcome. After a lumpectomy, radiation to the whole breast is the current gold standard.

How does radiation actually work?

Radiation works by aiming it at a target. Free radicals are produced which kill cancer cells, while normal cells have the capability to repair the damage. Cancer cells don’t.

Having the most advanced technology available to precisely plan and deliver radiation to the target will protect healthy tissue for optimal outcomes and the best possible cosmetic result.

How can I make sure I receive the best radiation?

The radiation oncologists treating you should be part of an interdisciplinary team. I, for example, work closely with the patient, the breast surgeons and the medical oncologists. I then design a personalized radiation plan, tailored to the unique characteristics of the tumor and each patient’s personal preferences. The more personalized the treatment the better.

To allow patients to feel their best during and after treatment, I often work with physical therapists, naturopaths, and other support staff (social worker, dietitian etc).

What type of radiation treatment do I need?

Radiation options after a breast conserving surgery can be very confusing. Here is a list that may help you understand the different options.

Whole Breast Radiation:
Standard whole breast radiation is given daily Monday through Friday over 6 to 6.5 weeks. Very small doses of radiation are given daily to give the normal cells the best chance to repair from the radiation damage. Tumor cells cannot repair the radiation damage and will die.

Active Breathing Coordinator
Because the left breast sits next to the heart, special techniques have been developed to minimize or eliminate exposure of the heart to radiation. The active breathing coordinator (or ABC) delivers radiation while the heart is as far from the radiation field as possible. 

TomoTherapy
Another option is TomoTherapy, an advanced form of radiation, optimal for very complex radiation treatment planning. 

Accelerated Partial Breast Irradiation (APBI) – Invasive: Brachytherapy
In some cases, it is possible to shorten the course of radiation by placing a balloon catheter in the lumpectomy cavity and delivering the radiation into the balloon. This technique can deliver a full treatment in 5 treatment days rather than the 6 week course. The device moves with the patient and the doses can be optimized and modified to minimize the amount of radiation to the ribs or skin. .

Accelerated Partial Breast Irradiation (APBI) with external non-invasive radiation - CyberKnife
The CyberKnife is one of the most advanced systems to plan and deliver radiation. Our team has pioneered the use of the CyberKnife for breast cancer, offering the advantages of brachytherapy without the need for an indwelling device. Treatment is one time per day for five to ten days. Click here to learn more about CyberKnife as an option to deliver radiation for breast cancer.

Accelerated Partial Breast Irradiation (APBI) with external non-invasive radiation - 3DCRT
Three dimensional conformal radiation therapy (3DCRT) delivers the radiation with image guidance allowing for very precise delivery. Treatment is two times per day for 5 days.

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The options available for breast cancer treatment will vary for each patient. Most importantly, the physician team will carefully consider with the patient which of these options would be best.

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