University of Virginia Health System

Breast Health

Whole-Breast Radiation For Breast Cancer Gets Thumbs Up

Further Understanding Of Partial-Breast Therapy Sought In NCI Study

It is called partial-breast irradiation, and proponents see it as a promising alternative treatment for breast cancer patients who have just had a lumpectomy.

Thousands of women have already sought out the therapy, which requires just one week or less of radiation after breast cancer is diagnosed, instead of the six or seven weeks required for whole-breast irradiation.

But its long-term benefits remain unproven, some experts caution.

That is why the National Cancer Institute (NCI) has launched a major study of this experimental therapy this fall, to offer women sound guidance based on years of observation.

Dr. Gary Freedman, a radiation oncologist at Fox Chase Cancer Center in Philadelphia, is urging a cautious approach.

Dr. Freedman says some studies looking at the benefits of partial-breast irradiation five years after treatment have produced acceptable results. But, he adds, "Five-year results aren't long enough to say, 'This is a standard alternative.'"

Interest in partial-breast irradiation heightened after the US Food and Drug Administration (FDA) approved a new radiation device in 2002. Bearing radioactive seeds, it is implanted after a lumpectomy into the site from which the tumor has been removed and then delivers radiation to that area only, not the entire breast.

The therapy is proving popular with women who find the short timetable far more convenient.

This year, more than 200,000 people in the US will be diagnosed with breast cancer, according to American Cancer Society (ACS), and more than 40,000 are expected to die from the disease.

Whole-Breast Radiation Versus Partial-Breast

Partial-breast irradiation is based on the fact that most recurrences of cancer appear at the site of the original tumor, not other parts of the same breast.

Whole-breast irradiation works by treating the entire breast with radiation to prevent undetected cancer cells that might have escaped from the original tumor from spreading to other parts of the same breast.

Dr. Freedman presented a study at the annual meeting of the American Society of Therapeutic Radiology and Oncology on the benefits of whole-breast irradiation.

He reported that the follow-up data on whole-breast irradiation is much longer than that for the newer technique. His research also showed that 15 years after a lumpectomy, the cancer recurrence rates were nearly the same at both the original tumor site as well as other parts of the breast.

Dr. Freedman evaluated 2,700 women who had whole-breast irradiation to assess the cancer recurrence rate in that breast.

After five years, the recurrence rate at the original tumor site was 3 percent, while it was 1 percent in other parts of the same breast. After 10 years, it was 6 percent at the original site and 2 percent in other parts of the same breast. But after 15 years, the recurrence rates were 9 percent at the initial cancer site and 7 percent in other parts of the same breast.

This suggests that whole-breast irradiation must remain the standard - at least for now, Dr. Freedman.

More Studies Needed, Experts Say

Dr. Herman Kattlove, a medical oncologist and spokesman for the ACS, also counsels patience until more is known about partial-breast irradiation's long-term effectiveness.

"We're concerned that [partial-breast irradiation] hasn't been proven," he says. "It's too early to tell" if it will bear out as a treatment as effective as whole-breast irradiation. "I would recommend caution," he says.

"We're awaiting results of [the ongoing] clinical trials," he adds. "We need to have that data."

Dr. Freedman concurs. "Standard treatment is certainly [irradiating] the whole breast," he says. If women want to try the partial-breast irradiation treatment, he adds, they should do it in an approved clinical trial.

Always consult your physician for more information.

Partial-Breast Radiation Methods

The American Cancer Society provides the following information on partial breast radiation methods:

Low-dose Breast Implant - Women receive a low-dose implant during an eight-day hospital stay.

High-dose Needle Brachytherapy - From outside the breast, physicians place 10 needles with slender tubes in and near the tumor area. They insert tiny "seeds" for a few minutes twice a day for four days.

Catheter Balloon Device - a physician inserts a catheter into the tumor cavity during a lumpectomy or through a small incision a few days later. A balloon device goes in, is filled with saline solution, and radioactive "seeds" are guided in for five minutes twice a day for about a week.

External beam radiation - Some centers can treat part of the breast with external radiation equipment. They focus four or five beams on the tumor site, rather than the whole breast. This is also known as quadrant irradiation.

Always consult your physician for more information.

Promising New Radiation Therapies

Many new radiation techniques are being used and studied to find more effective treatments for cancer. Some of the more promising therapies are described below:

radiation and chemotherapy in combination
Depending upon the particular type of cancer, physicians may choose to combine radiation with chemotherapy. Radiation may help to shrink tumors before surgery, for example, and chemotherapy may be used afterward to kill cancer cells not removed by surgery. Research is being conducted in this area.

intraoperative radiation
Intraoperative radiation is the use of radiation during surgery to treat cancerous tumors or other forms of cancer. This treatment decreases the area of affected tissue because a larger dose of radiation can be used. For some people, intraoperative radiation improves the outcome of their treatment. Intraoperative radiation may be used in addition to external radiation.

stereotactic radiation
This is an important new development in the treatment of brain cancer. Stereotactic radiation is the use of a single high dose of radiation sent into cancerous tissue with very narrow beams of radiation. This is a precise technique that is painless. An example of this technique is called the “gamma knife."

particle radiation therapy
Particle radiation therapy is the use of higher-energy radiation particles in cancer therapy. It may work well to treat tumors that recur after being removed, or tumors that cannot be treated through surgery.

three-dimensional (3D) conformal radiation therapy
Protocols and techniques for three-dimensional conformal radiation therapy are being developed. This type of therapy may help the cancer care team visualize and treat tumors in a more precise way than ever before.

thermoradiotherapy (hyperthermia)
Scientific experiments have shown that the use of high temperatures localized at the treatment site improves the success of radiation therapy. Further research is currently being conducted to learn more about this treatment option.

radioimmunotherapy
This type of radiation therapy involves using antibodies "tagged" with a special substance. These tagged antibodies recognize tumor cells and bind with them. By doing so, the antibodies bring cancer medication in contact with the tumor. Radioimmunotherapy may be helpful in treating cancer that has spread to other parts of the body.

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Cancer Society

American Society for Therapeutic Radiology and Oncology

American Society for Clinical Oncology

Centers for Disease Control and Prevention (CDC)

National Institutes of Health (NIH)

National Women's Health Information Center

January 2004

Whole-Breast Radiation For Breast Cancer Gets Thumbs Up

Whole-Breast Radiation Versus Partial-Breast

More Studies Needed, Experts Say

Partial-Breast Radiation Methods

Promising New Radiation Therapies

Radiation Therapy Facts

Risks and Side Effects of Radiation Therapy

Online Resources

Radiation Therapy Facts

Radiation therapy is given through different methods, depending on the type of cancer, the location of the cancer, and the patient's health.

Sometimes, radiation therapy is used in combination with other treatments. The following are some of the different types of radiation therapy with brief explanations of their goals:

external radiation (external beam therapy)
With external radiation (external beam therapy), radiation is administered by a large machine that points the energy waves directly at the tumor. The radiation therapist controls the machine. Since radiation is used to kill cancer cells, special shields may be made to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.

internal radiation (brachytherapy, implant radiation)
With internal radiation (brachytherapy, implant radiation), a high dose of radiation is given inside the body as close to the cancer as possible. The radiation treatment may be swallowed, injected, or implanted directly into the tumor.

Some of the radioactive implants are called “seeds” or “capsules”. Internal radiation involves administering a higher dose of radiation in a shorter time span when compared with external radiation.

Some internal radiation treatments stay in the body temporarily; other internal treatments stay in the body permanently, although the radioactive substance loses its radiation within a short period of time.

Risks and Side Effects of Radiation Therapy

Radiation therapy is a painless cancer treatment, though it can irritate skin.

The biggest risk of radiation therapy involves potential damage to normal cells, in addition to the cancerous cells. This damage to the normal cells can cause some side effects, which will be monitored and treated by your cancer treatment team.

As each person's individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent.

Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins. Consider the following potential side effects of radiation therapy:

skin irritation
Sometimes, radiation irritates the skin, causing it to become red, sore, and/or dry. For some people, skin irritation can become a troubling side effect. If you experience irritated skin during radiation treatment, consult your physician regarding how to treat the problem.

fatigue
Fatigue is a common side effect for all cancer patients. After weeks of radiation therapy, most people experience fatigue. Fatigue often resolves after treatment is completed.

Scientists have not determined the exact cause of fatigue. It may result from many factors, such as stress, pain, or a loss of sleep. Experts suggest that cancer patients with fatigue save their energy by limiting their activities.

Ask friends and family to help you with certain tasks, such as grocery shopping. Try to rest as much as possible. Also, including some light exercises, such as walking, into your daily routine may help you build energy.

hair loss (alopecia)
Hair loss can occur around the area being treated with radiation. For example, if you have radiation to your head you may lose hair on your scalp. However, if you are receiving radiation to your lung, you will not lose hair on your head. Hair usually grows back after treatment is finished.

If you experience hair loss on your scalp following treatment for a head or neck cancer, you may consider wearing a wig. Other people choose to wear a hat or scarf. Or you may decide that none of these options are right for you. If you choose to wear something on your head, make sure it is comfortable and does not irritate your skin.

blood changes
White blood cells and platelets can be affected by radiation therapy. Oncologists monitor blood counts during treatment to detect any problems. In some cases, the red blood cells can also be affected if radiation therapy is directed to large areas of bone marrow.

It depends on your blood count, but your physician may choose to adjust your treatment if your white blood cell and platelet counts decrease. Since these blood cells fight infections and prevent bleeding, treatment may even stop for a while until the blood counts increase.

oral health
Radiation treatment to the head and neck can cause dry mouth, difficulty in swallowing, cavities, gum destruction, sores in the mouth, redness and irritation, altered taste and smell sensations, and other side effects. It is important to take good care of your mouth, teeth, and throat during radiation therapy. Seeing a dentist before you start your radiation treatments can help prevent problems.

If you experience oral health problems during radiation treatment to the head or neck, talk to your physician and dentist about what you can do.

diarrhea, nausea, and vomiting
Radiation therapy to the abdomen or stomach may cause these side effects. Some patients experience nausea and an upset stomach a few hours after radiation treatment to the abdomen or stomach. Some patients find it helpful to eat a light meal a few hours prior to their treatment, while others prefer not to eat before their radiation treatment.

It is very important to maintain proper nutrition before, during, and after your radiation treatments. The main goal is prevent weight loss.

difficulty in eating
Eating may be difficult during treatment. Radiation treatment can interfere with your body's ability to absorb and digest food. It is also normal to lose weight during radiation therapy, but eating a balanced diet is important.

Talk to your physician or a registered dietitian regarding what you should eat if you experience problems such as a loss of appetite. Patients who eat well usually cope better with treatment, both mentally and physically.

Always consult your physician for more information.