What should breast cancer patients know about radiotherapy treatment?

Key Information Breast Cancer Patients Should Know About Radiotherapy

Postoperative radiotherapy is strongly recommended after breast-conserving surgery as it reduces the risk of local recurrence by two-thirds and has a beneficial effect on survival. 1

Purpose and Benefits of Radiotherapy

• Radiotherapy significantly reduces the risk of local breast cancer recurrence after surgery
• For breast-conserving surgery (BCS), radiotherapy:
  • Reduces local recurrence risk by approximately 66%
  • Provides survival benefits 1
  • Is considered standard treatment for all patients regardless of disease characteristics 2
• For mastectomy, radiotherapy is recommended for:
  • Patients with 4 or more positive axillary lymph nodes (category 1 recommendation) 1
  • Patients with T3-T4 tumors regardless of nodal status 1
  • Patients with 1-3 positive nodes with additional risk factors (young age, vessel invasion) 1

Standard Radiotherapy Protocol

• Timing: Usually begins 2-4 weeks after uncomplicated surgery 1
• Standard whole breast dose: 45-50 Gy delivered in 25-28 fractions of 1.8-2.0 Gy 1
• Alternative hypofractionation schedules:
  • 42.5 Gy in 16 fractions
  • 40 Gy in 15 fractions 2
• Boost dose: An additional 10-16 Gy to the tumor bed is recommended for:
  • Patients under 50 years of age 1, 3
  • Those with high risk of recurrence 1
• Treatment schedule: Daily treatments, Monday through Friday 1

Side Effects and Complications

Patients should be aware of potential side effects:

• Short-term effects:

  • Skin reactions (redness, irritation)
  • Fatigue
  • Breast swelling or tenderness

• Long-term effects:

  • Breast firmness or shrinkage
  • Skin changes
  • Potential cardiac toxicity (particularly for left-sided breast cancers) 1
  • Radiation pneumonitis (inflammation of lung tissue) 1

Follow-up Care After Radiotherapy

• Regular follow-up schedule:

  • Every six months for years 1-5
  • Annually thereafter 1

• Mammography schedule:

  • Baseline mammogram within 6-12 months after completing treatment
  • Annual mammograms thereafter 1

Special Considerations

• Pregnancy is a contraindication to radiotherapy 4
• Previous breast irradiation (including for Hodgkin's disease) contraindicates further radiotherapy 4
• Patients with scleroderma or systemic lupus erythematosus require special consideration 4
• For left-sided breast cancers, special techniques may be used to minimize heart exposure 1
• Radiation therapy techniques should avoid excess dose to heart and lungs 1

Breast Reconstruction Considerations

• Breast reconstruction is an option for women receiving surgical treatment for breast cancer 1
• The decision regarding type of reconstruction depends on:
  • Patient preference
  • Body habitus
  • Smoking history (increases complication risk)
  • Comorbidities
  • Plans for irradiation 1
• Radiation timing may need to be coordinated with reconstruction plans
• Patients should consult with a reconstructive surgeon before making decisions 1

Emerging Approaches

• Partial breast irradiation may be suitable for selected patients:
  • Women at least 50 years old
  • Unicentric, unifocal node-negative non-lobular breast cancer up to 3 cm
  • No extensive intraductal component or lymphovascular invasion
  • Negative margins of at least 2 mm 1

Understanding these aspects of radiotherapy can help breast cancer patients make informed decisions about their treatment and know what to expect during and after the radiotherapy process.