Management of Radiation Mastitis
Local heat application is the primary recommended treatment for radiation mastitis, as it helps improve blood circulation, reduces inflammation, and provides symptomatic relief. 1
Understanding Radiation Mastitis
- Radiation mastitis is an inflammatory condition of the breast that occurs as a side effect of radiation therapy used in breast cancer treatment 1
- It represents a specific form of radiation dermatitis affecting breast tissue following radiotherapy 1
First-Line Management
- Keep the irradiated area clean between treatments - this is the most important initial step 2, 1
- Apply local heat to improve circulation and reduce inflammation 1
- Non-perfumed moisturizers may be applied after cleaning for additional comfort 2, 1
- For mild cases (Grade 1), management can primarily be handled by nursing staff 2
Additional Topical Treatments
- Hydrophilic dressings applied after radiotherapy to the cleaned area may provide symptomatic relief 2, 1
- Anti-inflammatory emulsions (e.g., trolamine, hyaluronic acid cream) can be beneficial 2, 1
- Drying gels with antiseptics (e.g., chlorhexidine-based creams, but not chlorhexidine in alcohol) may be used when appropriate 2, 1
- Zinc oxide paste can be considered if it can be easily removed before subsequent radiotherapy sessions 2, 1
Management of Moderate to Severe Cases
- For moderate to severe cases (Grades 2-3), an integrated management team approach is recommended 2, 1
- The team should include radiation oncologists, nurses, medical oncologists, and dermatologists as required 2, 1
- Skin reactions should be assessed at least once weekly during treatment 2, 1
- Pentoxifylline therapy may be considered for chronic radiation dermatitis with cutaneous fibrosis 3
Management of Complications
- If infection is suspected, swab the area to identify infectious agents 2, 1
- Topical antibiotics should be reserved for confirmed superinfection and not used prophylactically 2, 1
- Check blood granulocyte counts if infection is suspected, especially in patients receiving concomitant chemotherapy 2, 1
- Perform blood cultures if signs of sepsis or fever are present 2, 1
Treatments to Avoid
- Danazol therapy is not indicated for radiation mastitis 1
- Therapeutic breast massage could potentially worsen inflammation and is not recommended 1
- Simple mastectomy is an extreme and inappropriate response to radiation mastitis, which is a manageable condition with conservative measures 1
- Overtreatment, including overuse of antiseptic creams, should be avoided as it can irritate the skin 2, 1
Prevention Strategies
- Use standardized radiation techniques to minimize skin reactions 2
- Appropriate dose fractionation (4,500 to 5,000 cGy at 180 to 200 cGy per fraction) helps minimize skin reactions 2
- Avoid using bolus during radiation treatment as it can increase skin reactions 2
- Proper patient positioning and treatment planning are essential to minimize unnecessary radiation exposure to normal tissues 2