Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation to the breast is often given after breast-conserving surgery to help lower the chance that the cancer will come back in the breast or nearby lymph nodes. This is needed less often in men with breast cancer than it is in women, mainly because breast-conserving surgery (such as lumpectomy) isn't done as much. Radiation may also be recommended after mastectomy in patients with either a cancer larger than 5 cm (2 inches) in size, or when cancer is found in the lymph nodes.
Radiation is also used to treat cancer that has spread, such as to the bones or brain.
When given after surgery, radiation therapy is usually not started until the tissues have been able to heal for about a month. If chemotherapy is to be given as well, radiation therapy is usually delayed until chemotherapy is complete.
External beam radiation
External beam radiation is the usual type of radiation therapy for men with breast cancer. The radiation is focused from a machine outside the body on the area affected by the cancer. This usually includes the chest wall where the breast was removed and, depending on the size and extent of the cancer, may include the underarm area, supraclavicular lymph nodes (nodes above the collarbone) and internal mammary lymph nodes (nodes beneath the breast bone in the center of the chest).
Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. They will make some ink marks or small tattoos on your skin that they will use later as a guide to focus the radiation on the right area. You may want to talk to your health care team to find out if these marks will be permanent.
Radiation therapy is much like getting a diagnostic x-ray, but the radiation is more intense. The procedure itself is painless. Each treatment itself lasts only a few minutes, but the setup time -- getting you into place for treatment -- usually takes longer.
The most common way breast radiation is given is 5 days a week (Monday thru Friday) for about 6 to 7 weeks. In studies of women with breast cancer, giving radiation over 3 weeks has been shown to be just as effective as giving it over 5 to 6 weeks. This, known as hypofractionated radiation therapy, has not been studied in men (because breast cancer is so rare in men).
Brachytherapy
Brachytherapy, also known as internal radiation, is another way to deliver radiation therapy. Brachytherapy is rarely used to treat breast cancer in men because it is only used in someone who has had a lumpectomy. Instead of aiming radiation beams from outside the body, radioactive seeds or pellets are placed directly into the breast tissue next to the cancer. It is often used as a way to add an extra boost of radiation to the tumor site (along with external radiation to the whole breast), although it may also be used by itself (see below). Tumor size, location, and other factors may limit who can get brachytherapy. There are different types of brachytherapy.
Intracavitary brachytherapy: This method of brachytherapy consists of a small balloon attached to a thin tube. The deflated balloon is inserted into the space left by the lumpectomy and is filled with a salt water solution. (This can be done at the time of lumpectomy or within several weeks afterward.) The balloon and tube are left in place throughout treatment (with the end of the tube sticking out of the breast). Twice a day a source of radioactivity is placed into the middle of the balloon through the tube and then removed. This is done for 5 days as an outpatient treatment. The balloon is then deflated and removed. This system goes by the brand name, Mammosite®. This type of brachytherapy can also be considered a form of accelerated partial breast irradiation. Like many forms of accelerated breast irradiation, there are no studies comparing outcomes with this type of radiation directly with standard external beam radiation. It is not known if the long-term outcomes will be as good.
Interstitial brachytherapy: In this approach, several small, hollow tubes called catheters are inserted into the breast around the area of the lumpectomy and are left in place for several days. Radioactive pellets are inserted into the catheters for short periods of time each day and then removed. This method of brachytherapy has been around longer (and has more evidence to support it), but it is not used as much anymore.
Possible side effects of radiation therapy
The main short-term side effects of radiation therapy are fatigue and sunburn-like skin changes. Your health care team may advise you to avoid exposing the treated skin to the sun because it may make the skin changes worse. Most skin changes go away in a few months.
Radiation to the breast/chest can sometimes damage some of the nerves to the arm. This, called brachial plexopathy, can lead to numbness, pain, and weakness in the shoulder, arm and hand.
Radiation therapy of the axilla (underarm area) can cause lymphedema (discussed earlier in “Types of breast surgery” in the “Surgery” section), particularly if the lymph nodes have been surgically removed. In rare cases, radiation therapy may weaken the ribs, which could lead to a fracture.
In rare cases, radiation therapy may weaken the ribs, which could lead to a fracture. In the past, parts of the lungs and heart were more likely to get some radiation, which could lead to long-term damage of these organs in some patients. Modern radiation therapy equipment allows doctors to better focus the radiation beams, so these problems are rare today.
A very rare complication of radiation to the breast is the development of another type of cancer called an angiosarcoma. These rare cancers can grow and spread quickly.
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