What is Postmastectomy Breast Cancer Radiation Therapy?
A modified radical mastectomy, which involves removing the entire breast, is commonly used as the main treatment for women with advanced stages of breast cancer. This procedure is also an option for some women in the early stages of breast cancer. They may choose this route for aesthetic reasons, to prevent possible effects from radiation, or because they have a genetic mutation that increases their risk of developing breast cancer again.
Often, during a mastectomy, a few lymph nodes from the armpit area are also removed and examined. This is known as sentinel lymph nodes biopsy or axillary node dissection. These are done to check if cancer has spread.
After the mastectomy, some patients may need to undergo post-mastectomy radiation therapy (PMRT). This is mostly recommended for those with more developed disease, or for those who have certain risky pathological traits. PMRT has been effective in improving local control of the disease and overall survival for some patients by directing radiation at the chest wall and the nearby lymph nodes, which help in draining fluids from the breasts.
Understanding the main aspects of PMRT is the focus of this discussion. This information is essential as it can help patients understand what to expect during their treatment journey.
Risk Factors and Frequency for Postmastectomy Breast Cancer Radiation Therapy
Locally advanced breast cancer is a complex condition that affects different groups of people, including those who have large primary tumors, widespread lymph node disease, or inflammatory breast cancer. In 2013, up to 40% of breast cancer patients had cancer that had spread to their regional lymph nodes, and 10% had a primary tumor that was 5 centimeters or larger. But contrary to most other types of cancer, patients with locally advanced breast cancer have a good chance of survival. The 5-year survival rate, specifically for breast cancer, can be anywhere from 78% to 90%.
- Locally advanced breast cancer involves different groups, including those with large tumors, widespread lymph node disease, or inflammatory breast cancer.
- In 2013, up to 40% of breast cancer patients had cancer spread to lymph nodes, and 10% had a tumor that was 5 centimeters or larger.
- Despite this, the survival rate for people with locally advanced breast cancer is better than for most other types of cancer.
- The 5-year survival rate is between 78% to 90%.
Treatment Options for Postmastectomy Breast Cancer Radiation Therapy
Research has shown that giving radiation therapy after mastectomy (removal of the breast) can be beneficial for patients with high-risk breast cancer. This is particularly true for patients with four or more affected lymph nodes, as post-mastectomy radiation therapy, also known as PMRT, can reduce the chances of the cancer returning and lower the risk of death from breast cancer.
However, there are ongoing debates about whether this method is effective for patients with less than four affected lymph nodes. It’s a topic that’s still being researched, and currently, the National Cancer Center Network recommends considering PMRT for these patients while also considering other factors like age, other health conditions, tumor size, and the specifics of the cancer itself.
Another controversial topic is whether PMRT should be done for patients who have a tumor larger than 5 cm but no affected lymph nodes. Research suggests that the risk of the cancer returning is low for these patients.
Another discussion revolves around the effectiveness of PMRT in patients who have responded well to chemotherapy before surgery. Some argue that these patients may not need PMRT, while others believe there isn’t enough evidence to omit PMRT in these cases.
If patients have internal mammary nodes (lymph nodes located near the breastbone) that are affected, these should be included in the radiation therapy. However, there is a debate on whether this step should be taken as a precaution for all patients as it could increase the risk of long-term harm to the heart and lungs.
It’s also important to note that having radiation therapy after breast reconstruction surgery can lead to complications such as changes in the shape of the breasts and more surgeries. This issue should be thoroughly discussed with patients who are thinking about undergoing immediate breast reconstruction.
In the end, these controversies highlight the need for a personalized, case-by-case approach to deciding on post-mastectomy radiation therapy.
Possible Complications When Diagnosed with Postmastectomy Breast Cancer Radiation Therapy
Postmastectomy radiation therapy is usually well-tolerated and doesn’t interfere with a patient’s daily routine. It does not decrease a person’s immunity or cause them to feel ill. Patients undergoing this therapy are not radioactive and can safely interact with others. There are, however, some potentially adverse effects or ‘toxicities’ related to this therapy, both short and long-term.
Short-term or ‘acute’ side-effects typically occur during and for about three months after the treatment. These often include feelings of being tired, a temporary aching throat, and radiation dermatitis. Radiation dermatitis is skin irritation that can worsen as more treatments are performed. It may cause skin redness, darkening, rash, and dryness. Extreme instances may result in wet peeling of skin. To alleviate these symptoms, patients are advised to keep their skin well moisturized throughout their treatment. Using topical agents such as aloe, hydrocortisone, or silver sulfadiazine can provide relief from burning and itching, and can help with the desquamation or peeling of the skin. If the areas of desquamation are large, hydrogel or hydrocolloid dressings can be applied. The skin needs to be monitored regularly for any signs and symptoms of infection.
Usually, the skin heals well 2 to 4 weeks after treatment although some patients may have long-lasting darkening of the skin and deeper tissue fibrosis or scarring.
Long term or ‘chronic’ side-effects related to postmastectomy radiation therapy often include darkening and fibrosis of the chest wall, which can interfere with cosmetic outcomes for patients undergoing breast reconstruction. Other potential toxicities extend to include radiation pneumonitis, rib fracture, bloody build-up in the arm, radiation-induced heart disease, hypothyroidism, and a very low risk of secondary cancer.
Particularly distressing is chronic arm lymphedema, a treatment-related complication resulting in swelling and heaviness of the limb, aching, tightness, and fatigue. Lymphedema ranges from 11% to 15% one to five years post-treatment and usually increases if a prior axillary dissection was performed. Effective measures to reduce the incidence of lymphedema include lymphedema education, compression sleeves and pumps, regular exercise, and personal preventive actions.
Another severe late side effect of radiation therapy includes an escalated risk of heart disease. Past studies indicate an increased risk of serious coronary events with each unit increase in radiation dose to the heart. However, with improved modern radiation techniques, this risk is believed to be reduced.
Different radiation therapies can affect the dose of radiation reaching the heart and lungs, especially when comprehensive lymph nodes are treated. Proton beam therapy reportedly decreases the dose to the heart and lung. Although the clinical impact of this dose reduction is still unknown, ongoing trials aim to evaluate these effects.
In conclusion, treatments like postmastectomy radiation therapy can come with both acute and chronic side effects. However, with modern advancements and appropriate preventive measures, these effects can be managed to ensure the patient’s health and safety.
Effects of radiation therapy:
- Feeling of being tired
- Temporary sore throat
- Radiation dermatitis
- Hyperpigmentation and subcutaneous fibrosis
- Increased risk of heart disease
- Hypothyroidism
- Secondary cancer
- Rib Fracture
- Arm lymphedema
- Radiation pneumonitis
