What you should know about radiotherapy after mastectomy: sessions and side effects

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Radiotherapy is a regular part of breast cancer treatment and, although it will depend on the case, it is generally applied after surgery -when it has healed- and after chemotherapy treatments. According to the Spanish Society of Radiotherapy Oncology (SEOR) , it is usually applied “in early stages for irradiation of the breast after conservative surgery; in intermediate stages for treatment of the chest wall and lymph node, axillary, supraclavicular or internal mammary areas; and, in advanced stages for irradiation of metastases”. The ultimate goal of radiation therapy is to minimize the chances that the cancer will come back.

Although treatments are increasingly personalized and tailored, let’s see in general what radiotherapy consists of in a global treatment of breast cancer.

What radiation therapy is used to treat breast cancer and how long the treatment lasts

Radiotherapy can be external – irradiating the areas to be treated externally with a machine – and internal (brachytherapy) – placing a device with radioactive pellets in the tumor bed. The first is the most common in breast cancer treatments and can be done in various ways depending on the stage of the disease or the location of the tumor.

After removal of the tumor. If a lumpectomy or breast-conserving surgery has been chosen, because the tumor was small or very localized, it is most likely that the entire breast will be irradiated, placing special emphasis on the area where the tumor was located. .

In some cases, if the tumor is very small and in very early stages, accelerated partial breast irradiation (APBI) is increasingly chosen. That is, radiating only the area where the tumor was located instead of the entire breast, with higher doses and for a shorter time. There are cases in which radiation is applied even at the time of the operation (intraoperative radiotherapy -IORT-) or with internal radiotherapy.

After a mastectomy. If you have chosen to remove all the breast tissue, you can choose to:

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Radiotherapy in the chest area. If the lymph nodes are not affected, radiation therapy will be given to the entire chest wall, the mastectomy scar, and the areas of the surgical drains. The goal is to reduce the risk that the cancer may come back in the remaining tissues of the chest wall or in the lymph nodes.

Radiation to lymph nodes. If the lymph nodes under the arm are already affected, radiation will also be given to these areas.

Radiation to other areas of the body. In case of metastases, radiation should also be administered to these areas.What side effects can radiotherapy cause?

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As for the duration, it depends on each patient, but, in general, thanks to advances in this technique, there is an increasing tendency to reduce the number of sessions. Thus, while a few years ago they used to consist of daily doses, five days a week, for five-seven weeks, currently, a sufficient dose can be administered in three-four weeks and sessions can be more concentrated.

What side effects can radiotherapy cause?

Radiotherapy can be external – irradiating the areas to be treated externally with a machine – and internal (brachytherapy) – placing a device with radioactive pellets in the tumor bed. The first is the most common in breast cancer treatments and can be done in various ways depending on the stage of the disease or the location of the tumor.

After removal of the tumor. If a lumpectomy or breast-conserving surgery has been chosen, because the tumor was small or very localized, it is most likely that the entire breast will be irradiated, placing special emphasis on the area where the tumor was located. .

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In some cases, if the tumor is very small and in very early stages, accelerated partial breast irradiation (APBI) is increasingly chosen. That is, radiating only the area where the tumor was located instead of the entire breast, with higher doses and for a shorter time. There are cases in which radiation is applied even at the time of the operation (intraoperative radiotherapy -IORT-) or with internal radiotherapy.

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