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By Mayo Clinic staffRadiation therapy plays an important role in the treatment of breast cancer. When given after surgery, radiation therapy generally begins a few weeks following your operation. If you're planning to receive chemotherapy, radiation therapy is typically given after you've completed your chemotherapy treatment. Hormone therapy is generally given after any chemotherapy and may be given at the same time as radiation.
Here are the main ways radiation therapy is used to treat breast cancer:
Radiation after lumpectomy
Radiation therapy for breast cancer is almost always recommended after surgery that removes only the tumor (lumpectomy). A lumpectomy alone, without radiation therapy, carries a relatively high risk of cancer recurrence in the affected breast months or years later because of microscopic deposits of cancer left behind after surgery. Radiation helps to destroy remaining cancer cells. Lumpectomy combined with radiation therapy is often referred to as breast-conservation therapy.
In clinical trials comparing lumpectomy with and without radiation therapy, the addition of radiation therapy after a lumpectomy resulted in significantly decreased rates of breast cancer recurrence.
Radiation after mastectomy
Removal of the entire breast (mastectomy) usually means you won't need radiation therapy. But radiation therapy is sometimes recommended for women at high risk of cancer recurrence following mastectomy. Factors that may put you at high risk of breast cancer recurrence in your chest wall — and thus call for radiation therapy — include:
- Lymph nodes with signs of breast cancer. Underarm (axillary) lymph nodes that test positive for cancer cells are an indication that some cancer cells have separated from the primary tumor. The greater the number of positive nodes, the more likely your doctor is to recommend radiation therapy. Most experts agree that having four or more positive nodes is a clear indication for radiation therapy after mastectomy, although recent data suggest that even women with one to three positive lymph nodes may benefit from radiation therapy.
- Large tumor size. A tumor greater than 5 centimeters (about 2 inches) in diameter generally carries a higher risk of recurrence than smaller tumors.
- Tissue margins with signs of breast cancer. After breast tissue is removed, the margins of the tissue are examined for signs of cancer cells. Very narrow margins or margins that test positive for cancer cells are a risk factor for recurrence.
Radiation for locally advanced breast cancer
Radiation therapy can also be used to treat:
- Breast tumors that cannot be surgically removed.
- Inflammatory breast cancer, an aggressive type of breast cancer that spreads to the lymph channels of the skin covering the breast. People who have this type of breast cancer typically receive chemotherapy before a mastectomy, followed by radiation, to decrease the chance of the cancer's returning.
Radiation for managing metastatic complications
If breast cancer has spread to other parts of your body (metastasized) and a tumor is causing pressure on the spine, for example, radiation can be used to shrink the tumor and reduce pressure.
- Breast cancer. American Cancer Society. http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/index. Accessed July 21, 2010.
- Pierce LJ. Techniques and complications of breast and chest wall irradiation for early stage breast cancer. http://www.uptodate.com. Accessed July 21, 2010.
- Sabel MS, et al. Role of radiation therapy in breast conservation therapy. http://www.uptodate.com. Accessed July 21, 2010.
- Pierce LJ. Postmastectomy chest wall irradiation. http://www.uptodate.com. Accessed July 21, 2010.
- Moataz NE, et al. Radiation techniques for locally advanced breast cancer. http://www.uptodate.com. Accessed July 21, 2010.
- Understanding radiation therapy. American Society of Clinical Oncology. http://www.cancer.net/patient/All+About+Cancer/Cancer.Net+Features/Treatments%2C+Tests%2C+and+Procedures/Understanding+Radiation+Therapy. Accessed July 21, 2010.
- Radiation therapy and you: Support for people with cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/coping/radiation-therapy-and-you/page1. Accessed July 25, 2010.
- Side effects of radiation therapy. American Society of Clinical Oncology. http://www.cancer.net/patient/All+About+Cancer/Cancer.Net+Features/Side+Effects/Side+Effects+of+Radiation+Therapy. Accessed July 21, 2010.
- Radiation therapy-What to expect. American Society of Clinical Oncology. http://www.cancer.net/patient/All+About+Cancer/Cancer.Net+Features/Treatments%2C+Tests%2C+and+Procedures/Radiation+Therapy%26mdash%3BWhat+to+Expect. Accessed July 21, 2010.
- Breast cancer treatment (PDQ): Health professional version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional. Accessed July 23, 2010.
- Brachytherapy. American College of Radiology and Radiological Society of North America. http://www.radiologyinfo.org/en/info.cfm?pg=brachy. Accessed July 25, 2010.
- Radiation therapy. Breast Cancer Network of Strength. http://www.networkofstrength.org/information/treatment/radiation.php. Accessed July 25, 2010.
- Moynihan TJ (expert opinion). Mayo Clinic. Rochester, Minn. Aug 1, 2010.
- Schomberg PJ (expert opinion). Mayo Clinic. Rochester, Minn. Aug 11, 2010.
- Smith BD, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Journal of the American College of Surgeons. 2009;209:269.
- Vaidya JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. The Lancet. 2010;376:91.
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