The guide to radiation therapies

Consultant breast oncologist Dr Shiroma De Silva-Minor understands values the importance of providing comprehensive information about the types of radiotherapy used in the treatment of breast cancer. In this article, she imparts her expertise in radiotherapy so that patients can explore their options and be informed before they begin treatment.

Radiotherapy, also known as radiation therapy, is a critical component of multidisciplinary care for breast cancer patients, aimed at targeting and destroying cancer cells while minimizing damage to surrounding healthy tissue. There are several types of radiotherapy commonly used in the management of breast cancer, each offering unique benefits and considerations:
 

External Beam Radiation Therapy (EBRT)

External beam radiation therapy is the most common form of radiotherapy for breast cancer. During EBRT, a high-energy radiation beam is delivered from an external machine directly to the area of the breast affected by cancer. This precise targeting allows the radiation to effectively destroy cancer cells while minimizing exposure to adjacent normal tissues. EBRT is typically administered over a course of several weeks, with daily treatments scheduled to ensure the cumulative dose reaches the tumour while sparing healthy tissue.

Intensity-Modulated Radiation Therapy (IMRT)

Intensity-modulated radiation therapy is an advanced form of EBRT that uses computer-controlled linear accelerators to deliver precise radiation doses to the breast and, if indicated, regional lymph nodes. IMRT allows for modulation of the intensity to 'sculpt' the radiation beams to the area needed and to spare the adjacent organs. This enabling the radiation oncologists like myself to tailor the dose distribution to the unique contours of the tumour while shielding nearby critical structures from excessive radiation. This technology is particularly beneficial for patients with complex tumour shapes or those who require radiation to areas near sensitive organs, such as the heart or lungs.

Partial Breast Irradiation (PBI)

Partial breast irradiation delivers radiation specifically to the area of the breast where the tumour was removed, rather than treating the entire breast. PBI is administered using external beam and is only suitable for selected patients with early-stage breast cancer who have undergone breast-conserving surgery (lumpectomy). By focusing radiation on the immediate vicinity of the tumour cavity, PBI aims to reduce treatment duration and minimise radiation exposure to healthy breast tissue, potentially resulting in shorter courses of therapy with comparable outcomes to whole breast irradiation.

Intraoperative Radiation Therapy (IORT)

Intraoperative radiation therapy involves delivering a concentrated dose of radiation directly to the tumour bed during the surgical procedure to remove the cancer. This approach allows for targeted radiation delivery while the surgical site is exposed, reducing the potential for radiation exposure to surrounding tissues and organs. IORT may be suitable for carefully selected patients with low-risk early-stage breast cancer and offers the advantage of completing radiation therapy in a single session at the time of surgery, eliminating the need for postoperative radiation treatments.

Brachytherapy

Brachytherapy, also known as internal radiation therapy, involves the placement of radioactive sources or seeds directly into the breast tissue near the tumour site. This localized delivery of radiation allows for a high dose to be concentrated in the target area while minimizing exposure to healthy tissues. Brachytherapy may be administered as a temporary implant (high-dose rate brachytherapy) or as a permanent implant (low-dose rate brachytherapy). It is often used as an alternative to whole breast irradiation in carefully selected patients with early-stage breast cancer who have undergone breast-conserving surgery.

As a breast oncologist, I recognise the significance of tailoring radiotherapy approaches to each patient's unique clinical characteristics, tumour biology, and treatment goals. I work closely with surgeons, pathologists, radiologists and other members of the breast multidisciplinary team, to develop bespoke treatment plans that optimise the benefits of radiotherapy while minimising potential side effects and long-term impact on quality of life.

In addition to discussing the various types of radiotherapy, it is essential to address potential side effects and long-term considerations associated with each approach. Open discussions with patients regarding the anticipated benefits and risks of radiotherapy is crucial in supporting informed decision-making and empowering patients to actively participate in their treatment.
 

If you are wanting to explore treatment for breast cancer, you can contact Dr De Silva-Minor via her Top Doctors profile.