R diotherapy

a
Introduction
• What is radiotherapy?
• When is radiotherapy used?
• What side effects and complications are
associated with the use of
radiotherapy?
• What are the different types of
radiotherapy?
 What is radiotherapy?
• The medical use of ionizing radiation in the
treatment of malignant cancers.
• May be used as curative, neo-adjuvant,
adjuvant or palliative treatment.
• Frequently used in combination with other
treatment strategies.
• Types:
 External Beam Radiotherapy
(EBRT)
 Brachytherapy
When is radiotherapy used?
• To reduce the risk of local recurrence following
carcinoma of the breast – 40%.
• Some patients with Ductal Carcinoma in situ if
high grade.
• Mastectomy patients with large, high grade,
multifocal tumours involving 4 or more lymph
nodes.
 When is radiotherapy used?
• Post-operative:
• Minimal tumour bulk following surgery.
• Minimal effect on wound healing.
• No delay of surgery.
• Decreases local recurrence from 10-40%
(according to extent of surgery) to <5%.
• Improves disease-free survival and overall
survival.
 When is radiotherapy used?
• Palliative RT
• Treatment of symptomatic manifestations.
• Improves quality of life.
• Used to treat distant metastases – brain, bone,
soft tissues.
• Effective, convenient, cost-effective with tolerable
side effects.
• Can only be administered following four cycles of
chemotherapy (12 weeks).
Side Effects of Radiotherapy
• Acute:
• Nausea and vomiting
• Skin desquamation

• Late:
• Fibrosis
• Alopecia
• Lymphoedema
• Pneumonitis
• Cancer
• Cardiac problems
Late Effect: Radiation Vascular Disease

• Intimal thickening of arteries and arterioles

• Dilatation of capillaries and venules
• Substantial reduction of the capillary
vascular bed
• Ischaemia
• Fibrosis
WHAT ARE THE DIFFERENT
TYPES OF RADIOTHERAPY?

External Beam Internal

Radiotherapy Radiotherapy
(EBRT) (Brachytherapy)
External Beam Radiotherapy
• Linear accelerators are the most common
source
• Conventional radiotherapy
• Conformal radiotherapy
• Intensity-modulated radiotherapy (IMRT)
 Internal Radiotherapy
(Brachytherapy)
• Radiation source is placed inside or next to the area
requiring treatment

• Radiation is delivered through catheters or a mammosite

balloon device which remains in place for the duration of
treatment

• Can be given after the whole breast has been treated

using
EBRT, providing a ‘boost’

• Can be used as the sole method of radiotherapy after

surgery
Conclusion
• Radiotherapy remains a key tool in the treatment of
breast cancer and in reducing the incidence of
recurrence.

• Whilst side effects of nausea, vomiting and skin

erythema are common, new techniques are
reducing toxicity.

• As research in this field progresses, radiotherapy

will undoubtedly continue to improve.
References
• Sainsbury, JRC; Anderson, TJ; Morgan, DAL. ABC of breast
diseases: Breast cancer. BMJ. 2000; 321: 745.

• Early Breast Cancer Trial Collaborative Group. The Effects of

radiotherapy and surgery in early breast cancer: an overview of the
randomised trials. N. Engl. J. Med. 1995; 333: 1444-44.

• Kurtz JM. Radiotherapy for early breast cancer: was a

comprehensive overview of trials needed? Lancet. Vol 355: No
9217, 2000; 1739-1740.

• Fisher B. Bauer M. Margolese R. et al. Five year results of a

randomised clinical trial comparing total mastectomy and segmental
mastectomy with or without radiation in the treatment of breast
cancer. N.Eng. J. Med. 1985; 312: 665-73.
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