Breast Cancer Awareness Month 2020: Breast cancer holds the first rank amongst all types of cancer globally as well as nationally. Breast cancer is managed by surgery; which may involve either complete breast removal (mastectomy) or removal of only the cancer lump with a rim of normal tissue to ascertain all cancer has been removed (breast conservation surgery) along with addressing lymph nodes in the axilla, depending upon disease stage. The probability of local relapse (cancer returning at the same site) is higher with breast conservation surgeries since there is a possibility of some microscopic cells not visible to the naked eye being left behind. Even when the entire breast is removed, there are certain adverse features observed, details of which are provided in the histopathological report, may signify a high risk of local relapse. To minimize these relapses, it is essential to incorporate radiation therapy after surgery.
What is radiation therapy? Radiation therapy is a form of treatment involving high energy X-rays which attack the DNA. After the attack, the damaged cells attempt to repair the damage, if the repair is successful, the cell lives; however, if the repair is not successful, the cell dies. Repair capacity of cancer cells is much less compared to normal cells, thus resulting in the preferential killing of cancer cells.
Breast Cancer: Role Of Radiation Therapy Explained By Dr Jatin Bhatia (Consultant- Radiation Oncologist, Jupiter Hospital, Pune)
- Radiation therapy is usually delivered in the form of 15 daily sittings from over three weeks to the areas at high risk of local relapse, which includes entire breast/chest wall and in some cases when nodes in axilla are involved, the lower neck on the same side.
- Now even some centres are delivering a higher dose over five days and finishing it. There are certain situations where more than 15 sittings are required, for example, after breast conservation surgery when further five sittings are given to the area of cancer; sometimes with the help of latest techniques (IMRT), this can be incorporated while delivering the 15 sittings.
- Also, there are situations, especially breast cancers which are diagnosed very early, can be delivered only to the site of breast cancer, and there are multiple techniques available to provide this type of radiation such as via teletherapy (linear accelerators), brachytherapy and intra-operative radiation therapy (IORT).
Breast Cancer: Is radiation therapy safe?
- Radiation therapy in breast cancer is usually a very safe procedure with chances of severe side effects being less than 5% by keeping the doses to the lungs below as low as possible, however, special care is taken for left-sided breast cancer patients, due to its proximity to the heart.
- To minimize the doses occasionally, there is a technique called as Gating or Deep Inspiratory Breath Hold (DIBH), where the patient holds her breath (usually not more than 20 seconds) under supervision of trained staff, which expands the lungs pushing the heart away from the left breast, thus reducing exposure.
- Even in last stage breast cancers, radiation therapy plays a vital role in providing pain relief, preventing pathological fractures, cessation of bleeding.
Conclusion: To conclude, radiation therapy is an integral part of breast cancer treatment almost at every stage and decision of therapy plan should be taken in a multidisciplinary setting involving surgical oncologists, medical oncologists and radiation oncologists.
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