Radiation

Radiation is another medical treatment option that may be used in a similar fashion to chemotherapy, in that it acts as either a good clean up tool following a lumpectomy or mastectomy to clean the margins, or as a preliminary treatment plan to reduce the size of a tumor that is going to be excised. There are a few key differences between chemotherapy and radiation, however, which must be weighed when choosing how to proceed with each individual patient. First, radiation is a very local procedure, meaning that only the areas targeted by radiation therapy will be affected. This is different from chemotherapy, in which the entire body is affected during treatment. Additionally, after radiation therapy is used on a given body part once, it cannot be used again on the same area due to risk of damaging normal cells near the treatment site.

In radiation, the targeted cancer cells and neighboring healthy cells are exposed to a high energy beam that damages the DNA of all cells within its path. Normal cells are not reproducing as fast as cancerous cells, and so changes to their DNA are not realized as quickly as in cancerous cells. In addition, the DNA repair mechanisms in cancer cells have been compromised compared to normal cells, and so they are unable to fix the damage caused by radiation as well as normal cells exposed to the same dosage. While this means that normal cells exposed to radiation will not experience as negative of effects as nearby cancer cells, it has been proven that the same does not hold true for a second round of radiation to the same population, and as such radiation is only prescribed once to a given area of the body. Radiation can be administered in two forms, through the use of an external beam or a “seed,” which is a pellet placed in the body near the cancerous area that emits the same kind of high energy waves as the beam. Due to the damaging nature of these beams, it is also not possible to undergo radiation therapy if the patient is pregnant, due to the risk of damaging the fetal cells.

Radiation is a much more localized process than chemotherapy, meaning that there will be little to no damage of hair cells and other cells of the body as with chemotherapy. However, there are still some side effects to be aware of before beginning radiation therapy. The most common side effect of radiation treatment is an effect very similar to sunburn appearing in and around the treatment area on the patient’s skin. After all, the sun releases UV rays, which is another form of radiation, so a similar effect from radiation therapy is a realistic possibility. It is important to treat these areas of the skin as if it were regular sunburn. In other words, do not pick at the affected areas and consult with the radiation specialist to determine if there are any skin care products that could be used during or after radiation treatment to alleviate the irritated areas.

There are a few other side effects that have been noted by patients undergoing radiation therapy, namely armpit discomfort, fatigue, and lowered white blood cell counts. Armpit discomfort is expected due to the armpits’ close proximity to the breasts that are undergoing treatment. If this occurs, simple steps may be taken to fix this problem, such as refraining from using strong soaps and deodorants for the duration of the therapy regimen. Fatigue is another manageable side effect, and should not be unexpected by patients undergoing treatment. Simple lifestyle changes may help to fight fatigue, such as regular naps, healthy diet, and exercise. A low white blood cell count is perhaps the most serious side effect felt by patients, in that their ability to fight off infection from lesser bacteria and viruses is severely compromised. Patients should always talk to their therapist while undergoing treatment to determine when they are at a higher risk of infection, at which points they should avoid crowded public places and friends and family members who are suffering from any kind of contagious illness, including the common cold.

Brachytherapy - Accelerated Partial Breast Irradiation (APBI)

Brachytherapy is a form of accelerated partial breast irradiation (APBI) where a radioactive source is placed inside or next to the area requiring treatment via a “radiation balloon applicator”. Brachytherapy delivers internal targeted radiation directly to the breast tissue surrounding the lumpectomy cavity (the space that is left after the tumor is removed and the area where cancer is most likely to recur) rather than irradiating the entire breast.

APBI offers the convenience of a short course of treatment, usually 10 high-dose radiation applications done twice-daily over 5 days.  By contrast, external beam radiotherapy usually requires 5 to 7 weeks of treatment post-operatively.

Requirements for APBI typically include: a diagnosis of invasive breast cancer or ductal carcinoma in situ (DCIS), age ≥ 50, small tumor ≤ 3 cm, negative surgical margins at 2mm, negative nodal status and no lymphovascular invasion.

Brachytherapy may be a suitable treatment option for early stage breast cancer.