Frequently Asked Questions*

* Also see Conditions We Treat, Breast Cancer.

Why is radiation recommended after the tumor is surgically removed?

Surgery to remove the tumor and preserve the remaining breast tissue is called a lumpectomy. Radiation treatment is given to destroy any remaining microscopic deposits of cancer in and around the site of surgery. The combination of lumpectomy followed by radiation therapy is considered equal to mastectomy, or removal of the entire breast. If radiation is omitted following lumpectomy alone, there is a high likelihood of cancer recurrence in the breast.

What are the common side effects of radiation therapy to the breast?

Side effects can include fatigue, skin irritation similar to a moderate sunburn, and mild to moderate breast swelling. These changes are temporary and can be treated by skin creams and/or medications. Tell your radiation oncologist or nurse about any discomfort you may feel.

What is Accelerated Partial Breast Irradiation (APBI)?

Accelerated partial breast irradiation (or APBI) is the delivery of radiation to only part of the breast over four to five days. By treating a smaller area of the breast, treatment can be completed in just one week. While it is not yet considered standard practice, there is reason to believe that APBI may be equivalent to 5 to 7 weeks of external beam radiation therapy. Thousands of patients are being actively evaluated in national clinical trials—data on these patients must be collected over 10 to 20 years to see if APBI is as effective as the standard external beam treatment. Currently, it is used most often for patients who find it impossible to travel to and from the clinic for a standard radiation therapy course.

How is APBI performed?

Breast brachytherapy involves placing flexible plastic tubes called catheters or a balloon into the breast. During treatment, the catheters or the balloon are connected to a machine which sends out a small radioactive seed directly into the catheter which is placed where the tumor was removed. The radiation is left in place for several minutes, twice a day. After the end of the five days, the catheters or balloon are removed.

Who is a candidate for APBI?

Not everyone is a candidate for APBI. Patients must qualify based on the current guidelines of the American Brachytherapy Society and American Society of Breast Surgeons. The recommendations are: 1. Age > 45, 2. Invasive ductal carcinoma or DCIS subtypes only, 3. Tumor size < 3cm, 4. Negative surgical margins, and 5. Sentinel or axillary nodes negative. In addition, there are several technical factors which must be determined based on a planning CT scan such as placement of the catheter and adequate spacing between the catheter and skin surface. It is important that all patients understand between 20-30% of all catheters inserted must be removed due to technical factors. These patients are still candidates for external beam radiation.

Should I consider Proton Beam radiation?

No. Proton beam is actually an older technology developed in the 1950’s for very specialized types of tumors. There is no clinical data to support the use of proton beam therapy over conventional radiation treatment in breast cancer.

Does choosing to have a mastectomy guarantee I will not need radiation?

No. Unfortunately, there are circumstances where radiation is recommended even after a mastectomy is performed. Whether or not radiation therapy should be used after removal of the breast depends on several factors. These factors include lymph node involvement, tumor size, and whether or not cancer cells were found near the edge of the tissue that was removed. You should see a radiation oncologist to discuss these possibilities before you decide which type of surgery to undergo.

* Also see Conditions We Treat, Breast Cancer.