What are the side effects of breast radiation treatment?

Side Effects of Breast Radiation Treatment

Breast radiation therapy commonly causes skin reactions, fatigue, and lymphedema, with potential long-term effects including cardiac toxicity and secondary malignancies. These side effects can significantly impact quality of life but are generally manageable with proper care and monitoring.

Common Acute Side Effects

Skin Reactions

• Radiation dermatitis: Affects up to 90% of patients receiving breast radiation 1
  • Ranges from mild erythema to more severe reactions including:
    • Dry desquamation (dry, flaky skin)
    • Moist desquamation (skin breakdown with weeping)
    • In rare cases, ulceration and necrosis 2
  • Typically develops within 1-2 weeks of starting treatment
  • Modern radiation techniques (IMRT, hypofractionation) have reduced severity 3
  • Management options:
    • Non-hormonal, water-based lubricants and moisturizers 4
    • Vitamin E acetate in lipophilic gel base for severe cases 2

Fatigue

• One of the most common side effects of breast radiation 5
• Does not increase linearly with cumulative dose
  • Often drops from first to second week
  • Increases in third week
  • Plateaus around fourth week of treatment
  • Typically resolves within 3 weeks after treatment completion 5

Breast/Chest Wall Changes

• Breast edema
• Breast shrinkage
• Telangiectasia (visible small blood vessels)
• Skin thickening 4
• These changes are typically most pronounced in the first 6-12 months and stabilize within 2 years 4

Long-Term Side Effects

Lymphedema

• Risk factors:
  • Axillary lymph node dissection
  • Radiation to supraclavicular or axillary nodes 4
  • Obesity 4
• Incidence varies widely, estimated to affect over 40% of survivors to some degree 4
• Can cause:
  • Swelling of arm, breast, or chest wall
  • Discomfort to overt pain
  • Limitation of fine motor function
  • Increased risk of cellulitis 4

Cardiac Effects

• Increased risk of cardiac dysfunction
  • Risk is higher with left-sided breast radiation
  • Risk increases with radiation to internal mammary lymph nodes 4
• Modern techniques (deep inspiration breath-hold, prone positioning) help reduce cardiac exposure 4

Sexual Health Issues

• Radiation can cause:
  • Skin fibrosis
  • Loss of sexual sensitivity of the skin
  • Uncommonly, cardiac and respiratory damage affecting sexual function 4

Secondary Malignancies

• Rare but serious late effect
• Includes risk of angiosarcoma and other radiation-induced cancers 6

Special Considerations

Radiation Techniques Affecting Side Effect Profiles

• Hypofractionated radiation (40-42.5 Gy in 15-16 fractions):
  • Preferred over conventional fractionation (46-50 Gy in 23-25 fractions)
  • Associated with fewer radiation-related effects on normal breast tissue 4
• Intensity-modulated radiation therapy (IMRT):
  • Improves dose homogeneity
  • Spares normal tissues 4
• Respiratory control techniques:
  • Deep inspiration breath-hold
  • Prone positioning
  • Reduce dose to heart and lungs 4

Follow-up Recommendations

• Physical examinations every 3-6 months for first 1-3 years, then annually 4
• Mammography:
  • First post-treatment mammogram 6 months after radiation
  • Every 6 months during first year
  • At least annually thereafter 4
  • Important to compare with previous studies to distinguish treatment changes from recurrence

Prevention and Management Strategies

• CT-based treatment planning to limit heart and lung exposure 4
• Weight loss for overweight/obese patients to reduce lymphedema risk 4
• Prompt referral to lymphedema specialist for symptoms of swelling 4
• Integrative approaches with evidence of benefit for radiation-induced toxicity:
  • Calendula cream
  • Massage
  • Oil-in-water emulsion 4

By understanding and anticipating these side effects, clinicians can better prepare patients and implement strategies to minimize their impact on quality of life during and after breast cancer treatment.