Breast Cancer: Radiation Therapy

Pictured: Beryl McCormick & Simon Powell Beryl McCormick, Chief of the External Beam Radiation Service, and Simon Powell, Chair of the Department of Radiation Oncology, lead efforts to improve radiation therapy for breast cancer.

Radiation therapy uses high-energy x-rays to destroy cancer cells. At Memorial Sloan Kettering, radiation therapy is used in many different situations for breast cancer patients.

  • Following a lumpectomy, radiation is focused on the breast and sometimes the surrounding lymph node area to destroy any stray cells that may have been left behind. This treatment reduces the chance of a recurrence of cancer.

    In addition to using radiation to target the entire breast with the cancer (this approach is considered the standard of care), Memorial Sloan Kettering is evaluating an approach called partial breast radiation in which radiation is delivered only to the section of the breast with the cancer.

  • We also offer an intraoperative radiation program of partial breast irradiation for older women with very early breast cancer. At the time of the lumpectomy, radiation is applied directly to the area of the breast where a tumor was removed and adds, on average, only 30 minutes to the time spent in the operating room. This approach eliminates the need for postoperative radiation.
  • Radiation therapy is sometimes also given after a mastectomy, but only if there is a high risk of cancer recurring in that area. Our plastic surgeons and medical oncologists work together to offer an integrated program of post-mastectomy radiation to women who have undergone immediate reconstruction and require radiation treatment. Our approach has resulted in both excellent local control of the cancer and a low rate of major radiation-related problems with reconstruction.
  • Patients who need systemic therapy, such as chemotherapy, may receive radiation after chemotherapy is completed.

Your oncologist, breast surgeon, radiation oncologist, and plastic surgeon (if reconstruction after mastectomy is planned) will work together to decide the best sequence of treatments. A course of standard radiation therapy for breast cancer typically includes five days of treatment a week for four to six weeks. At each session, which generally lasts about 15 minutes, the patient lies on a special treatment table.

Recent clinical studies have demonstrated that hypofractionated radiation treatment, in which shorter courses of radiation are given to the breast, is as effective as the longer conventional course. More radiation is given during each visit. Your radiation oncologist will determine whether this is an option for you.

New Approaches in Radiation Therapy

Memorial Sloan Kettering offers several newer forms of radiation therapy for breast cancer. These include:

Intensity-modulated radiation therapy (IMRT)

In IMRT, a special computer program is used to deliver a uniform, or homogenous, dose of radiation to the breast. This technology prevents the emergence of so-called hot spots (areas that receive more radiation than others due to the shape of the breast) and minimizes acute and late reactions. In special situations, IMRT is also used to limit the radiation dose to organs close to the breast or lymph nodes being treated.

Radiation delivered in the prone position

Some patients are able to lie on their stomachs instead of their backs, and radiation is directed to the affected breast as it hangs through an opening in a special table. This approach reduces radiation exposure to nearby vital organs such as the heart and lungs. It has been found to be especially useful for women with large breasts.

Image-guided radiation therapy (IGRT)

In IGRT, doctors and radiation therapists use imaging technologies to locate the tumor just before the radiation dose is given while the patient is in the treatment position. This results in a more accurate delivery of radiation directly to the tumor.

Proton Therapy

For some cases of breast cancer, our radiation oncologists can use proton therapy, an advanced form of radiation therapy, to deliver high doses of radiation to tumors that may be resistant to conventional forms while minimizing exposure to the surrounding healthy tissues. Proton therapy directs its cancer-fighting energy to precise locations within the body, allowing our doctors to deliver the necessary dose to the tumor — maximizing the chance of destroying it — while simultaneously lowering the dose to normal tissues and thereby reducing the risk of treatment-related side effects. Currently, this cutting-edge technology is available at only 14 locations in the United States.   

While all of these special technical innovations are available at Memorial Sloan Kettering, some applications are limited to clinical trials. Your radiation oncologist can discuss the specifics of your case during your consultation.

Radiation treatments today are very precise, resulting in little harm to surrounding skin or healthy tissues. Radiation is generally very well tolerated, but after approximately three weeks there may be some side effects, such as a sunburn-like condition on the skin, fatigue, discoloration of the skin, or swelling and heaviness in the breast. Your radiation oncologist will explain in detail what to expect and when side effects are likely to appear. He or she can also prescribe a topical skin cream to minimize the side effects.