A Fox Chase Women's Cancer Center Program

Radiation Therapy for Breast Cancer

Radiation Techniques for Breast-Conserving Treatment

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Computerized 3-dimensional treatment planning and IMRT at Fox Chase Cancer Center represent the most advanced radiation therapy. Fox Chase radiation oncologists have been using IMRT longer than anyone else in the region--making ours one of the most experienced teams in the country.

Radiation oncologists at Fox Chase report their patient outcomes, which are generally more successful than national averages, in national publications.

A multi-specialty team of radiation oncologists, surgeons and medical oncologists at Fox Chase work together to develop the most effective treatment plan for each breast cancer patient.

After undergoing breast-conserving surgery, many women receive radiation therapy to the remaining breast tissue to stop the growth of undetected cancer cells. Radiation reduces the chance of recurrence (likelihood that the cancer will return). This combination of breast-conserving surgery and radiation therapy has long been considered the safe and effective alternative to mastectomy for many women.

IMRT, 3-D Planning and Mammosite™-Radiation Therapy for Breast Cancer

Radiation therapy can be delivered by way of 2 different methods:

  • External beam radiation: A machine directs very high energy X-rays at the breast. External radiation is usually delivered while a woman is lying on her back on a treatment table.
  • Internal radiation, implant radiation or brachytherapy: Radioactive material placed temporarily in a catheter is inserted directly into the breast. This process requires that the catheter remain in the breast for up to 1 week before it is removed.
  • Image-Guided Intensity Modulated Radiation Therapy (IMRT)
    Side Effects of Radiation for Breast Cancer

    The good news:
    Apart from some
    general fatigue,
    there are few side effects associated with radiation therapy.

    IMRT has helped reduce the side effects associated with radiation. However, some women may develop 1 or more short-term side effects including a sunburn-like reaction on the areas of their skin that were irradiated, muscle stiffness, mild swelling and tenderness. Others may have no obvious side effects. Long-term side effects may include firmness, tenderness, changes in size and skin color of the irradiated breast. In clinical studies that compare radiation of the breast versus mastectomy, there was no increase of cancer associated with radiation therapy.Our radiation oncologists are leaders in state-of-the-art, image-guided IMRT. They continually conduct research on newer methods to deliver breast radiation more rapidly or to smaller areas of the breast. This highly specialized technology is an advance in the way that radiation is planned and delivered to the breast.IMRT can be optimally designed to deliver radiation to the breast while sparing surrounding healthy tissue and organs with a precision not possible with traditional radiation treatment. IMRT works by allowing the radiation beams to vary in intensity, dividing each beam into smaller, more focused beams that precisely target the breast cancer tumor.

    IMRT has improved the way radiation is delivered to patients to reduce side effects during and after treatment. Women receiving IMRT have less risk of breast pain and burning or peeling of the skin during radiation compared to women treated with conventional radiation. This method is particularly beneficial for women with large breast sizes, reconstructed breasts and left-sided breast cancers. This is because IMRT delivers radiation as evenly as possible to the skin and different parts of the breast. It reduces the dose given to areas of the heart and lung that lie just beneath the chest for women with left-sided breast cancers.

    IMRT has significantly greater complexity than conventional radiation, and Fox Chase physicians have a team of physicists and therapists to plan and safely deliver the treatment.
  • 3-Dimensional Radiation Planning
    Physicians use a computer linked to the newest state-of-the-art CT scanner to create a 3-D image of the patient's breast and whole treatment area. This 3-D image of the tumor area is called a computerized tomography scan, or CT scan. It is necessary for using modern techniques of conformal and intensity modulated radiation therapy (IMRT). This technology allows doctors to design more accurate and safer treatments. This helps to reduce or eliminate the amount of radiation given to other organs, such as the lungs or heart. 3-D radiation helps doctors aim radiation more precisely at the area of the breast where the tumor is located.
  • MammoSite™
    Recent advances in brachytherapy allow doctors to apply this technology to provide radiation to the breast tumor, rather than irradiating the whole breast, which is generally performed. Brachytherapy with the MammoSite™ takes 5 days instead of up to 7 weeks that external radiation can require.

    Similar to brachytherapy, seeds are placed near the tumor in a temporary balloon. The balloon stays in the breast for 7-10 days and is placed either at the time of lumpectomy or afterwards under ultrasound. The placement takes only 10-20 minutes. It is performed with a local anesthetic without the need for stitches. The radioactivity is placed into the balloon twice a day for 5 days, each treatment taking only 5 minutes. Apart from these times, the balloon is not radioactive. After the last treatment, the balloon is deflated and easily removed from the breast. Doctors continue to study this technique to determine if it is as effective as external beam therapy for treating breast cancer.

Special Circumstances
(Reconstruction and Larger Breast Sizes)

Radiation of the Reconstructed Breast

After reconstructive surgery, radiation must be performed with expert care. Radiation oncologists at Fox Chase take special measures to make the radiation as safe as possible for these women and have extensive experience treating women with either saline implants or muscle transfer reconstructions.

Radiation used to be associated with high rates of complications to reconstructions. At Fox Chase, modifications have been made to routine radiation techniques that help make radiation safer for the reconstructed breast.

Fox Chase physicians have reported some of the best results in the nation with radiation in this setting, with our women having low risks of serious complications and excellent cosmetic results. These techniques include specially modified high-energy beams, IMRT and custom-shaped materials that fit the specific shape of the breast to optimize the radiation delivery.

Radiation for Large Breast Sizes

Women with large breasts require more radiation during treatment because of the larger treatment area. Historically, these women were denied breast conserving therapy because doctors worried they could not tolerate the side effects of radiation (for instance, peeling of the skin, breast pain, fibrosis or skin discoloration).

At Fox Chase, our doctors have special techniques to reduce the side effects of radiation in women with large or pendulous (severe drooping) breasts. We routinely use 3-D planning, modified higher energy radiation beams, custom support bras during treatment and the most advanced IMRT to improve the distribution of radiation throughout a large breast. These measures all further reduce the side effects in these women.

Researching Methods to Shorten Treatment

Partial Breast Radiation - Fox Chase is participating in a clinical trial designed for women who have undergone lumpectomy. Women who enroll in this trial will be split into two groups. The first will receive conventional radiation to the whole breast with a boost to the lumpectomy site over 6 - 6 1/2 weeks. The second group will receive a 1-week course of radiation using either the MammoSite technique or 3-D external beam therapy (2 times per day).

For more information, contact
Gary M. Freedman, MD
Associate Professor, Radiation Oncology, Women's Cancer Program
Director, Radiation Oncology Residency and Fellowship
Fox Chase Cancer Center
333 Cottman Avenue
Philadelphia, PA 19111
215-728-3016

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