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Partial breast radiation therapy - external beam

Carcinoma of the breast - partial radiation therapy; Partial external beam radiation - breast; Intensity-modulated radiation therapy - breast cancer; IMRT - breast cancer WBRT; Adjuvant partial breast - IMRT; APBI - IMRT; Accelerated partial breast irradiation - IMRT; Conformal external beam radiation - breast

Partial breast radiation therapy uses high-powered x-rays to kill breast cancer cells. It is also called accelerated partial breast radiation (APBI). A standard course of external beam breast treatment takes 3 to 6 weeks. APBI can be accomplished in as little as 1 to 2 weeks. APBI targets a high dose of radiation on the area where the breast tumor was removed. It avoids exposing the surrounding tissue to radiation. There are three common approaches for APBI:

  • External beam, the topic of this article
  • Brachytherapy (inserting radioactive sources into the breast)
  • Intraoperative radiation (delivering radiation at the time of surgery in the operating room)

Description

Radiation therapy is usually delivered on an outpatient basis, except for intraoperative radiation therapy.

Two common techniques are used for partial breast external beam radiation treatment:

  • Conformal external beam radiation
  • Intensity-modulated radiation therapy (IMRT)

Before you have any radiation treatment, you will meet with the radiation oncologist. This person is a doctor who specializes in radiation therapy.

  • The doctor will put small marks put on your skin. These marks ensure that you are correctly positioned during your treatments.
  • These marks will either be ink marks or a permanent tattoo. Do not wash ink marks off until your treatment is finished. They will fade over time.

The treatment is usually given 5 days a week for anywhere from 2 to 6 weeks. It may sometimes be given twice a day (usually with 4 to 6 hours between sessions).

  • During each treatment session you will lie on a special table, either on your back or your stomach.
  • The technicians will position you so the radiation targets the treatment area.
  • You may be asked to hold your breath while the radiation is being delivered. This helps limit how much radiation your heart receives.
  • Most often, you will receive radiation treatment for between 1 and 5 minutes. You will be in and out of the cancer center within 15 to 20 minutes on average.

Rest assured, you are not radioactive after these radiation treatments. It is safe to be around others, including babies and children.

Why the Procedure Is Performed

APBI is used to prevent breast cancer from coming back. When radiation therapy is given after breast-conserving surgery, it is called adjuvant (additional) radiation therapy.

APBI may be given after lumpectomy or partial mastectomy (called breast-conserving surgery) for:

  • Ductal carcinoma (DCIS)
  • Stage I or II breast cancer

Before the Procedure

Tell your health care provider what medicines you are taking.

Wear loose fitting clothes to the treatments.

After the Procedure

Radiation therapy can also damage or kill healthy cells. The death of healthy cells can lead to side effects. These side effects depend on the dose of radiation and how often you have the therapy. Radiation can have short-term (acute) or long-term (later) side effects.

Short-term side effects can begin within days or weeks after treatment begins. Most side effects of this type go away within 4 to 6 weeks after treatment ends. Most common short-term effects include:

  • Breast redness, tenderness, sensitivity
  • Breast swelling or edema
  • Breast infection (rare)

Long-term side effects may begin months or years after treatment and may include:

  • Decreased breast size
  • Increased firmness of breast
  • Skin redness and discoloration
  • In rare cases, rib fractures, heart problems (more likely for left breast radiation), or lung inflammation (called pneumonitis) or the development of second cancer years later
  • Arm swelling (edema) -- more common if lymph nodes were surgically removed and if the armpit area was treated with radiation

Your providers will explain care at home during and after radiation treatment.

Outlook (Prognosis)

Partial breast radiation following breast conservation therapy reduces the risk of cancer coming back, and possibly even death from breast cancer.

References

National Cancer Institute website. Breast cancer treatment (adult) (PDQ) - health professional version. www.cancer.gov/types/breast/hp/breast-treatment-pdq. Updated November 12, 2019. Accessed November 19, 2019.

National Cancer Institute website. Radiation therapy and you: support for people who have cancer. www.cancer.gov/publications/patient-education/radiationttherapy.pdf. Updated October 2016. Accessed August 2, 2018.

Shah C, Harris EE, Holmes D, Vicini FA. Partial breast irradiation: accelerated and intraoperative. In: Bland KI, Copeland EM, Klimberg S, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 51.

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    Breast cancer - Animation

    Of all the different types of cancers, breast cancer is one of the most talked about, and with good reason. One out of every eight women will develop breast cancer sometime in their life. That's why every woman should be thinking about how to protect herself from this disease. Breast cancer is cancer that forms in the breast. Usually, it begins in the tubes that transport milk from the breast to the nipple. If the cancer spreads to other parts of the breast or body, it's called invasive breast cancer. Some breast cancers are more aggressive, growing more quickly than others. Although women are 100 times more likely to develop breast cancer, men can also get the disease because they do have breast tissue. You're more likely to get breast cancer if you're over 50, you started your periods before age 12, or you have a close family member with the disease. Drinking more than a couple of glasses of alcohol a day and using hormone replacement therapy for several years also may increase your risk. The telltale sign of breast cancer is a lump in your breast or armpit. You may also notice a change in the shape, size, or texture of your breast, or have fluid coming from your nipple when you're not breastfeeding. If you notice any changes in your breasts, call your doctor. You'll probably need to have an imaging scan, such as a mammogram, MRI, or ultrasound. A piece of tissue may be removed from your breast, called a biopsy. With these tests, your doctor can tell whether you have breast cancer, and if so, determine whether or not it has spread. So, how do we treat breast cancer? That really depends on the type of cancer, and how quickly it's spreading. Your doctor may recommend that you have the cancer removed with surgery. Sometimes it's enough just to remove the lump. That's called a lumpectomy. In other cases, the doctor will need to remove the entire breast to get rid of all the cancer or prevent it from coming back. That's called a mastectomy. Other treatments for breast cancer include chemotherapy, medicines that kill cancer cells, and radiation therapy, which uses energy to destroy cancer. Women whose cancer is fueled by the hormone estrogen may receive hormone therapy to block the effects of estrogen on their cancer. Today's breast cancer treatments are better than ever. Many women who have breast cancer go on to live long, healthy lives. The outlook really depends on how fast the tumor is growing, and how far it has spread. That's why it's so important to report any changes in your breasts to your doctor as soon as you notice them. Women who are at an especially high risk for breast cancer because of their family history can talk to their doctor about taking medicine or even having surgery to reduce their risk.

  • Breast cancer

    Animation

  •  

    Breast cancer - Animation

    Of all the different types of cancers, breast cancer is one of the most talked about, and with good reason. One out of every eight women will develop breast cancer sometime in their life. That's why every woman should be thinking about how to protect herself from this disease. Breast cancer is cancer that forms in the breast. Usually, it begins in the tubes that transport milk from the breast to the nipple. If the cancer spreads to other parts of the breast or body, it's called invasive breast cancer. Some breast cancers are more aggressive, growing more quickly than others. Although women are 100 times more likely to develop breast cancer, men can also get the disease because they do have breast tissue. You're more likely to get breast cancer if you're over 50, you started your periods before age 12, or you have a close family member with the disease. Drinking more than a couple of glasses of alcohol a day and using hormone replacement therapy for several years also may increase your risk. The telltale sign of breast cancer is a lump in your breast or armpit. You may also notice a change in the shape, size, or texture of your breast, or have fluid coming from your nipple when you're not breastfeeding. If you notice any changes in your breasts, call your doctor. You'll probably need to have an imaging scan, such as a mammogram, MRI, or ultrasound. A piece of tissue may be removed from your breast, called a biopsy. With these tests, your doctor can tell whether you have breast cancer, and if so, determine whether or not it has spread. So, how do we treat breast cancer? That really depends on the type of cancer, and how quickly it's spreading. Your doctor may recommend that you have the cancer removed with surgery. Sometimes it's enough just to remove the lump. That's called a lumpectomy. In other cases, the doctor will need to remove the entire breast to get rid of all the cancer or prevent it from coming back. That's called a mastectomy. Other treatments for breast cancer include chemotherapy, medicines that kill cancer cells, and radiation therapy, which uses energy to destroy cancer. Women whose cancer is fueled by the hormone estrogen may receive hormone therapy to block the effects of estrogen on their cancer. Today's breast cancer treatments are better than ever. Many women who have breast cancer go on to live long, healthy lives. The outlook really depends on how fast the tumor is growing, and how far it has spread. That's why it's so important to report any changes in your breasts to your doctor as soon as you notice them. Women who are at an especially high risk for breast cancer because of their family history can talk to their doctor about taking medicine or even having surgery to reduce their risk.

    A Closer Look

     
     

    Review Date: 7/9/2018

    Reviewed By: David Herold, MD, Radiation Oncologist in West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 10/15/2019. Editorial update 11/19/2019.

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