Radiation Therapy for Breast Cancer: Which Type is Right for Me?

Radiation therapy is a common method used for treating breast cancer. Although it is typically not used alone, your oncologist may recommend it in addition to your other treatments due to its effectiveness at killing cancer cells. However, for some very early-stage breast cancer, internal radiation therapy could be the only treatment necessary.

There are two types of radiation therapy used to treat breast cancer: external beam radiation therapy and internal radiation therapy, also called brachytherapy. The goal of both types of radiation therapy is to kill any cancer cells that remain after surgery. 

What is External Radiation Therapy for Breast Cancer? 

External beam radiation is delivered from a machine outside the body. This machine, called a linear accelerator, moves around the body, precisely aiming beams at the cancer site from different angles.  

Before starting radiation, your breast cancer specialists will take images of the cancer site. This imaging is essential to identifying and setting the boundaries of the treatment area so accurate doses are given each time. At this time, your body may be marked with small tattoos, which help the radiation therapists line you up for treatment each day. 

During external beam radiation therapy, you will lie down, flat on a table, as the machine precisely delivers radiation to the cancerous site. The radiation specialist will ensure your positioning remains consistent during the session, which is crucial to maintaining accuracy. The procedure typically causes no pain, though side effects may occur post-treatment. 

External radiation can be used in a couple of different ways, such as:  

• Whole breast radiation
• Accelerated partial breast irradiation (APBI)

External radiation therapy for breast cancer typically involves a daily schedule, five days a week, spanning several weeks. Hyperfractionated radiation therapy, a newer option, may reduce the duration of treatment for many patients by delivering the same radiation amount in fewer sessions with higher doses per session. Each session is brief and painless. 

Accelerated partial breast irradiation (APBI) targets a smaller breast area, potentially shortening treatment time and reducing radiation exposure. Ongoing breast cancer research aims to compare APBI’s long-term effectiveness with whole breast radiation.

The Use of External Radiation Therapy for Breast Cancer

External radiation may be recommended for you based on your specific scenario, including:

1. Before surgery. Some patients may need to receive radiation before surgery to shrink a tumor so that it's easier to remove. Treatments given before surgery are called neoadjuvant therapy.
2. Post-lumpectomy. Your cancer care team will usually recommend radiation therapy after a breast-sparing surgery, called a lumpectomy, to eliminate any remaining cancer cells. Radiation after a lumpectomy helps significantly reduce the chance of breast cancer recurrence. 
3. After a mastectomy. Because the entire breast tissue is removed, radiation therapy may not be needed. However, in cases where the tumor exceeds 5 cm, it can be used to target any remaining cancerous cells in the area or to treat the chest wall if cancer cells were found there.
4. When breast cancer is affecting lymph nodes. If this happens, radiation therapy may be directed towards the affected node regions, such as those under the armpit, above the collarbone, or near the breastbone, regardless of the type of breast cancer surgery that was performed. 

Typically, if radiation therapy is recommended after surgery, it begins one to two months after the operation, allowing time for the surgical site to heal.

Internal Radiation Therapy for Breast Cancer Treatment

Internal radiation, known as brachytherapy, is a type of treatment for breast cancer. High-dose-rate (HDR) brachytherapy is the standard method, which involves strategically placing a radiation source within the body rather than delivering it externally. HDR is often used after breast-conserving surgery, such as a lumpectomy in early-stage cases. For some women with early-stage (0 or I) breast cancer, HDR brachytherapy may be the only treatment necessary.

In brachytherapy, the radiation oncologist inserts a small device into the breast at the tumor site. The radioactive seeds or pellets are temporarily placed through this device, left there for approximately 10 to 20 minutes per session, and removed.

This process is repeated several times and usually is done for three to five days. However, the exact duration is tailored to your specific needs. 

The Use of Internal Radiation Therapy for Breast Cancer

The American Brachytherapy Society recommends specific guidelines regarding the use of internal radiation therapy for breast cancer. All of the following should be met:

• The patient is age 45 or older and has recently had a lumpectomy, AND
• The tumor is 3 cm in size or smaller, AND
• The lymph nodes have no presence of cancer, AND
• There are “clear margins," meaning no cancer cells on the rim of healthy tissue that was removed along with the cancer. 

What Questions Should I Ask My Breast Cancer Specialist About Radiation Therapy?

It’s important to approach your cancer treatment with an understanding of what to expect. Before starting radiation therapy, you will meet with your radiation oncologist to discuss the process and the expected results. This is a great time to ask some important questions, such as: 

• What does my treatment schedule look like? How often will I have treatment, and how long will each session last? 
• What part(s) of my body will need to be treated with radiation? 
• What are the potential side effects of treatment? Are there things I can do to manage them? 

When asking these questions, feel free to take notes so you have the answers to your specific questions and can share them with your loved ones. 

Keep the lines of communication open with your care team as you progress through treatment. Regular discussions with your breast cancer specialists allows them to help you understand what’s normal, assist with any side effects you might be experiencing, and to get answers to questions you or your family have as the treatment process progresses. 

The Latest Radiation Therapy Options for Breast Cancer in Portland and Vancouver 

The Compass Oncology team of breast cancer oncologists and surgeons provide the latest methods of treatment including using radiation therapy. We are dedicated to helping each patient through their cancer journey. If you or a loved one in the Portland, Oregon, or Vancouver, Washington area was diagnosed with breast cancer, schedule a consultation with a breast cancer oncologist to learn more about your treatment options, which often include radiation therapy.