HJNO Nov/Dec 2023

48 NOV / DEC 2023 I  HEALTHCARE JOURNAL OF NEW ORLEANS ONCOLOGY DIAL GUE COLUMN ONCOLOGY Radiation Therapy Options for Early Stage Breast Cancer BREAST CANCER is the most common type of cancer in women and one of the top can- cer diagnoses every year around the world. Each patient with breast cancer — and duc- tal carcinoma in situ (DCIS), a pre-malignant condition — is treated differently based on their particular type of cancer and stage, but a general paradigm exists. Typically, a woman will undergo surgi- cal removal of the breast cancer — either by lumpectomy (removal of the breast tumor itself with margin) or mastectomy (removal of the entire breast) — along with assessment of the axillary lymph nodes. Surgery is com- monly followed by some combination of ra- diation therapy, endocrine therapy, or pos- sibly chemotherapy, depending on particular pathologic and molecular risk factors. One could write textbooks on breast can- cer and its multifaceted treatment, but I want- ed to focus on the role of radiation therapy in early breast cancer and its evolution over the past few years. treatment does not hurt, patients are not ra- dioactive, and there are generally no activity restrictions. Radiation side effects are generally local- ized to the area receiving the treatment, so they are different depending on the part of the body that is irradiated. Common side effects from radiation thera- py to the breast are, but not limited to, fatigue; skin irritation including erythema, dermatitis, itching, peeling, desquamation; and low risk of lung and cardiac toxicity depending on laterality of treatment and technique used. However, radiation therapy has evolved over many decades, and we are now finding many different options to treat women with breast cancer — often with improved side ef- fect profiles. We have also been able to use deep inspi- ration breath holding technique (DIBH) to reduce the amount of radiation going to the heart and lungs for women with left-sided breast cancer. By holding a deep breath, the Radiation therapy in breast cancer Radiation therapy has been used to treat breast cancer for many decades. External beam radiation therapy involves using target- ed X-rays, or photons, to irradiate the breast tissue and has shown benefit to reduce the chance of local recurrence of breast cancer. The machine that delivers the radiation is called a linear accelerator. We know that for most women with breast cancer, breast-conserving surgery with lumpectomy followed by radiation therapy has equal rates of cure versus mastectomy. Lumpectomy is typically an outpatient pro- cedure, much less invasive than mastectomy, and can provide good cosmetic outcomes. Some women will require mastectomy either for personal, genetic, or oncologic reasons, andmay or may not require radiation therapy afterward depending on pathologic findings. Radiation therapy is usually given daily for five days per week for three to six weeks and lasts about 20minutes per day. Receiving