At NYU Langone’s Perlmutter Cancer Center, doctors may use radiation therapy, which uses high-energy beams that kill cancer cells, to treat women with breast cancer.
Radiation Therapy After Breast-Conserving Surgery
Radiation therapy is most often used to prevent cancer from returning after breast-conserving surgery, also called lumpectomy. Radiation therapy usually follows chemotherapy in women who have had a lumpectomy.
Our doctors most frequently use external beam radiation therapy to manage breast cancer. This type of radiation therapy is delivered by a machine called a linear accelerator. The machine rotates around you during therapy to treat the entire breast. This therapy, called whole breast irradiation, is given five days a week for three to four weeks. At Perlmutter Cancer Center, we offer radiation therapy Sunday through Thursday or Monday through Friday.
Some women, such as those with cosmetic breast implants, may require longer courses of radiation therapy. Women with a history of lupus, scleroderma, or other connective tissue disease may require five to six weeks of radiation treatments.
Younger women may receive an additional week of radiation aimed at the tumor’s location in addition to whole breast irradiation. This is called the “boost” dose. This dose is sometimes provided at the same time as whole breast irradiation.
Some women may require treatment only to the area where the tumor was removed, an approach called accelerated partial breast irradiation. This treatment, available as part of a clinical trial, allows radiation to be completed in one week. It is generally provided to post-menopausal women with small, estrogen receptor-positive tumors.
Women with cancer in the lymph nodes that was found during surgery may require radiation to the lymph nodes as well as the breast. Typically, these women receive five to six weeks of radiation therapy.
Radiation Therapy After Mastectomy
Radiation therapy may also be recommended after a mastectomy for women with cancer in the lymph nodes or for those who may have cancer cells in the tissue margins around a tumor. Radiation therapy is directed at the reconstructed breast or the chest wall and the lymph node basins—the area where the nodes were surgically removed. Post-mastectomy radiation therapy typically takes five weeks.
Our experts ensure that the radiation therapy is delivered as precisely as possible. If you are receiving external beam radiation therapy, you are not radioactive in any way and do not need to limit contact with children or pregnant women.
Radiation Treatment Planning
Our radiation oncologists use CT scans of the target area and surrounding tissue and organs in conjunction with computer software to develop a customized treatment plan for you. This software creates a three-dimensional image of the target tissue and surrounding organs, and allows our doctors to determine how best to target the cancer while sparing as much nearby healthy tissue as possible. A radiation plan is designed specifically for you based on the location and type of tumor, the extent of the cancer, and your anatomy.
Our doctors may perform X-rays or CT scans during treatments to ensure that the radiation therapy is targeting the breast cancer and avoiding healthy tissue. This approach, called image-guided radiation therapy, helps compensate for organs moving during treatments, which may require an adjustment in radiation targeting. The technique also enables doctors to track the size and shape of the tumor over the course of treatment.
Prone Position External Beam Radiation Therapy
Perlmutter Cancer Center radiation oncologists helped pioneer prone external beam radiation therapy, which allows for better distribution of the treatment dose. During this approach, you lie in a prone position, or face down, rather than on your back, called the supine position.
Our doctors helped pioneer prone external beam radiation therapy, which allows for better targeting of the treatment dose while avoiding nearby organs, such as the heart or lungs.
This positioning lets gravity displace the breast tissue away from the body, allowing radiation oncologists to better target the breast tissue while avoiding the heart and lungs.
Another advantage of the prone position is that it greatly decreases the incidence of skin irritation. Radiation beams are evenly distributed throughout the breast and are less concentrated in the skin folds, as compared to radiation therapy given to women when they lie on their backs during treatment.
Whole breast radiation and partial breast radiation are typically delivered while you are in the prone position. After mastectomy, the supine, or back-lying position, is used for better targeting of the lymph nodes surrounding a tumor.
Deep Inspiratory Breath Hold
Deep inspiratory breath hold may be used in women with left-sided breast cancer who are treated in the supine position. In this therapy, you hold your breath so that the heart moves away from the left breast, minimizing the radiation dose to the heart and lungs. Delivery of the radiation beam is controlled by breathing.
Managing Side Effects
The most common side effects of radiation therapy for breast cancer are mild fatigue, skin darkening or reddening—much like a sunburn—and breast pain, discomfort, or sensitivity. These symptoms tend to be mild and build up over the course of treatment, peaking during the last week of radiation or the week after therapy ends. Doctors can prescribe topical skin creams to help manage these effects. They can also refer you to our support services and to Perlmutter Cancer Center’s integrative medicine services.
Serious side effects, such as heart or lung damage, are rare. They may be the result of radiation techniques such as prone breast irradiation and deep inspiratory breath hold, and CT-based radiation treatment planning.
You may be a candidate for clinical trials that test advanced treatments for breast cancer.Learn More
Perlmutter Cancer Center researchers are studying the optimal number of treatments for partial breast irradiation. Several techniques allow for lower radiation doses to reach the heart and lungs. Treatment is complete in one week.
Your doctor can help you decide whether a clinical trial is right for you, and help you enroll in one.
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