July 2018 Ask the Expert: Radiation Therapy

July 1, 2018

Radiation therapyinfo-icon is a common treatment for breast cancer. It can lower the risk of cancer returning. But not everyone needs it, and it’s available in a few different forms and on different schedules.

This July, Living Beyond Breast Cancer expert Nicole Simone, MD, radiationinfo-icon director of the Jefferson Breast Care Center in Philadelphia, answered your questions about radiation therapy and breast cancer.

Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare providerinfo-icon because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counselinginfo-icon or medical advice.

I have just been diagnosed with estrogen receptor-positive breast cancer. I am planning a lumpectomy but I am very afraid of radiation side effects on the heart and lungs, particularly in left breast. I am considering intraoperative radiation therapy but it is not provided anywhere near my location. Can you please provide information on how to find it and your opinion on this topic over whole breast radiation?

I am not sure where you live but I can provide some information. The great news is that women with early-stage breast cancerinfo-icon now have many options since we have long-term data from large randomized controlled trials with thousands of patients. We have come a long way with how we deliver radiationinfo-icon to minimize side effects. All radiation can have some long-term side effects, but the chances are small. The great thing about standard radiation, or external beam radiation, is that we are able to outline what we are targeting and what we aren't (heart and lungs) and we can add beams and work with our physics team to really make beautiful plans that treat the entire breast while minimizing the doseinfo-icon to other organs. We know what dose of radiation is tolerable to the heart and lungs before side effects would typically happen and we stay below those limits. It is true that a sliver of lung will get some dose, but in long-term studies there are no effects on lung function. Some people do have scarring of the lung in that region but this does not cause any problems for patients clinically. We also stay below limits for the heart but this very much depends on position of the heart during treatment. Many centers have now instituted a method to account for breathing motion during radiation treatment so that very precise radiation can be delivered to avoid the heart as much as possible.

Intraoperative radiation is great because you are able to have your surgeryinfo-icon and radiation done in one day! But there is not a lot of long term data for this method. In addition, because it is given in the operating room, it can be difficult to shape the radiation away from the heart and lungs. You should ask your team to review with you the position of the tumorinfo-icon and position of your heart, and understand what methods they will use to protect each. Best of luck!

What happens to bone mets that are irradiated? Are the tumor cells killed by the radiation?

For bone mets, we hope to kill some cells and stop them from growing but unfortunately, we do not give a doseinfo-icon that will kill all the cells. Radiationinfo-icon significantly helps with pain in these cases.

Can radiation treatment have a negative effect on or do damage to your lungs or breathing passages?

There can be a small amount of scarring in the lung that results from radiationinfo-icon in the long term. This does not affect your pulmonary function. Patients who are marathon runners do not have difficulty breathing and continue to do marathons without issue. So how does that scarring affect you? I typically tell my patients that when you are 95 years old and in the hospital and someone thinks you have pneumonia, you should remind the doctors that you have had radiation because the scarring from radiation can look very much like pneumonia but is not infectious at all.

Can you radiate a breast with a tissue expander in place? Does it have to be deflated?

You can absolutely radiate with an expander in place! We do it all the time! We don't typically deflate the breast we are treating, but sometimes, if a patient has expanders in both breasts, we deflate the side we are not treating to allow for optimal positioning of the radiationinfo-icon beams.

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