Breast cancer patients receiving radiation treatment face an increased risk of secondary malignancies such as lung or esophageal cancers.59
Current cancer guidelines advocate combining lumpectomy and radiation to specifically target any remaining cancer cells that remain. This reduces re-excision rates while increasing chances of achieving good cosmesis.
Proton therapy and carbon ion radiotherapy offer alternatives that could lower the risk of complications while treating tumors and surrounding tissue with radiation beams.
Integrative (holistic) methods
Many individuals find comfort from cancer and its treatment by turning to alternative or integrative approaches, including herbs, vitamins, massage therapy and bodywork. Although these approaches won’t cure breast cancer themselves, they can help relieve stress, fatigue, nausea/vomiting/pain/sleep issues as well as help manage any side effects from chemotherapy treatments such as hair loss.
Proton beam radiation therapy (PBRT), an innovative and promising radiotherapy method that uses protons instead of x-rays to treat tumors, has quickly gained in popularity among breast cancer survivors. PBRT allows doctors to increase dosage while decreasing collateral damage caused by radiation to healthy tissue nearby while simultaneously decreasing long-term cardiovascular events and secondary malignant tumors.
Endocrine therapy offers another alternative to radiation for treating breast cancer, by inhibiting estrogen production and slowing cancer cell growth. It is often combined with lumpectomy procedures to prevent future recurrences or spread.
Women who opt out of radiation after lumpectomy and decide not to have it can instead take five years’ worth of tamoxifen medication to prevent cancer recurrence as well as reduce their chances of a second primary cancer developing somewhere else in their breast or lung. This medication could prevent recurrences as well as lower chances of secondary tumors forming elsewhere in their bodies.
Radiation therapy can be an integral component of comprehensive management for breast cancer, but some women may be worried about any long-term adverse effects. To make an informed decision that’s best suited to you, discuss any concerns with health care providers and ask any pertinent questions.
Cardiotoxicity is a frequent and serious side effect of thoracic radiation exposure. This damage may come in two forms – either directly by radiation to heart tissues or indirectly via impaired functioning of endothelial cells and increased oxidative stress levels – leading to restrictive cardiomyopathy, coronary artery disease, pericardial effusions and even cardiac failure with preserved or reduced ejection fraction.
Proton therapy
Proton therapy employs proton beam radiation therapy as an effective cancer treatment option, targeting tumors directly while sparing nearby healthy tissues and organs from exposure. Furthermore, proton therapy has the potential of minimizing side effects more effectively than alternative cancer therapies.
Protons are subatomic particles found within every atom’s nucleus and travel along similar paths as X-rays; however, unlike their more widely distributed cousins they can be targeted with pinpoint accuracy to specific body areas for treatment with far fewer side effects than with photon therapy.
Proton radiation differs from X-rays by stopping when it reaches its intended area of treatment, helping reduce risks to other tissues or organs – including heart, lung and esophagus – when targeting breast cancer patients. This method also reduces radiation dose required and may lower a patient’s risk of secondary cancers.
A proton beam is generated in a device known as a synchrotron or cyclotron by dissecting hydrogen atoms into positive and negative electrons, creating proton particles. After being accelerated to near the speed of light, they’re directed into an area in the treatment room using magnets – where they’re directed with precision towards specific targets with ease. Furthermore, this device can rotate around its target to direct protons in different angles to reach all areas of tumor growth.
Once the proton beam has been directed toward the tumor, doctors use imaging scans to help them accurately map out its exact shape and location before creating a treatment plan with radiation oncologists who selects an ideal combination of dose and schedule to achieve desired outcomes.
Studies have demonstrated the numerous advantages that proton therapy provides women with early stage breast cancer, including lower rates of recurrence and reduced damage to healthy tissues nearby.
Proton therapy is more costly than traditional external radiation and not covered by all health insurance plans, making cost-acceptability an issue. To improve it, an APBI trial comparing conventional X-ray with proton therapy with the goal of reducing major complications is currently taking place.
Endocrine therapy
Endocrine therapy, or ETT, is a medication used to reduce estrogen production and therefore decrease the chance of cancer recurrence. It’s most frequently administered after surgery for estrogen-sensitive cancers that account for 80-90% of breast cancer cases; but preoperatively shrinking tumors before surgery might make your surgery simpler or more successful; additionally ETT may be combined with chemotherapy treatments in some instances.
Most women with hormone receptor-positive (HR-positive) breast cancer benefit from hormone therapy to decrease risk of local and distant recurrence and improve survival, but its exact impact depends on both premenopausal or postmenopausal status and which hormonal therapy they choose; Tamoxifen is often recommended; alternative options for postmenopausal women include aromatase inhibitors (AIs).
Some patients with hormone-sensitive cancers may not benefit from endocrine therapy and, due to other health complications, cannot access it. Therefore, they require other forms of treatment, such as radiation therapy.
Breast cancer patients must continue taking endocrine therapy after treatment has concluded; this can be difficult due to side effects caused by medications used during this phase. Side effects could include hot flashes, vaginal dryness and bone loss – potentially life-threatening situations for some individuals.
Many randomized trials have examined the feasibility of forgoing endocrine therapy after breast lumpectomy and radiotherapy for low-risk breast cancer patients; these early studies were small and only included select women. More recent randomized trials conducted among younger women with hormone-sensitive cancers found that forgoing treatment does not increase recurrence risk or mortality risks [46].
The REaCT-70 trial, currently recruiting participants at multiple centers across Canada, aims to assess the feasibility of forgoing endocrine therapy (ET) altogether in favor of short-course radiotherapy for patients aged 70 or over with clinically node negative, clinically node negative ER+/HER2- breast cancers that do not need ET and radiotherapy treatments. Multivariable Fine-Gray competing risks regression models will be used to compare outcomes between those receiving ET plus radiotherapy vs those not.
Breast surgery
Breast cancer surgery entails extracting both the tumor and any nearby lymph nodes, often followed by radiation therapy or chemotherapy treatments. Reconstructive surgery aims to restore breast shape. Depending on its size and stage, reconstruction might also include lumpectomy or mastectomy procedures.
Your doctor will use a local anesthetic to numb the area around the tumor. They may also give you mild sedative medication to make you more relaxed but awake during surgery. Once they find it using ultrasound imaging techniques or another imaging method, he or she will use needle to remove both tumor and some surrounding tissue (known as margin). When done, surgeon will examine tissue to ensure all cancerous cells have been extracted successfully.
After your surgery, you’ll be taken to a recovery room where a physician will monitor your blood pressure, heart rate and breathing. A bandage will cover your incision site; drains will collect fluid from it; you might experience pain or numbness in your underarm region as well as pinching sensations; you will also learn how to care for it properly, recognize signs of infection as well as activity restrictions.
Surgery may be enough to treat invasive breast cancer for many women. For noninvasive forms such as ductal carcinoma in situ (DCIS), such as lumpectomy may be performed to remove both the tumor itself as well as some healthy tissue surrounding it.
Some individuals require a mastectomy to completely and/or radicalally remove all their breast tissue, known as a complete or radical mastectomy. Mastectomy techniques have evolved over time. William Halsted described in 1890s radical mastectomy which involved removal of the entire breast along with pectoralis major fascia; today doctors often perform skin reducing mastectomy which removes some tissue while keeping the nipple intact.
Your doctor may suggest radiofrequency ablation (RFA), a heat therapy technique to destroy cancerous cells, as an alternative to whole breast radiation therapy (WBRT). A phase II trial found RFA could reduce the need for WBRT after lumpectomy; results of a larger multicenter study are still pending.
