Introduction
For patients with breast cancer, there are various treatment options. In principle, chemotherapy, radiation, hormone therapy and/or surgery are available. Which therapy the gynaecologist will choose depends on various factors, including the age of the woman and whether or not she has had her last period, the size of the tumour, certain tissue characteristics of the tumour, the extent of metastasis (spread) of the tumour and the hormone receptor status. Radiation therapy reduces the risk of relapse enormously and has therefore proven to be a firm therapy pillar.
When does breast cancer need to be irradiated?
Radiotherapy for breast cancer can be used for non-operable tumour types, i.e. primarily, in addition to surgery or palliatively, i.e. accompanying, pain-relieving and improving the quality of life. In the case of breast-conserving therapy or surgery in which not the entire breast but part of the glandular tissue is removed, radiotherapy is always relevant because it reduces the risk of a new tumour forming in the mammary gland tissue.
After a complete surgical removal of the breast, radiation therapy is recommended in the presence of more than 3 affected lymph nodes, if the patient is under 40 years of age, if the tumour has spread to lymphatic or blood vessels, or if complete freedom from tumour at the cellular level could not be achieved. Palliative radiotherapy is used to reduce pain or tumour size. In addition, it is possible to irradiate the breast affected by the tumour during the operation with an open mammary gland or wound.
With a few exceptions – such as older patients, very small tumour, no affected axillary lymph nodes – it is a supplement to external radiation and shortens the duration of radiation therapy after an operation. However, it does not replace it. Depending on the individual diagnosis of a patient, it may also be necessary to irradiate other areas of the body than just the breast.
Often radiotherapy of the lymphatic drainage system is carried out as a supplement, which usually affects either the armpit or the area just below the collarbone. This is because a breast tumour is the first to spread to these areas. Remote metastases (daughter tumours) of breast cancer can also be tackled with radiotherapy (radiation), but in this case it is usually only used to relieve pain or avoid secondary diseases (such as bone fractures in the case of bone metastases).
After a complete removal of the breast, radiotherapy is not necessarily necessary, the assessment of the treating physician is required. Normally, after such an operation, radiation therapy is only connected if the tumour was very large or had already affected breast muscles and/or skin. Treating breast cancer with radiation alone is rather the exception.
This approach is usually only taken if an operation proves unsuitable for certain reasons. This can happen, for example, in patients who refuse an operation on principle or in those who would be exposed to an above-average risk of surgery because of their advanced age or other diseases. The radiation dose used for this primary therapy is higher than that used as a supplement to surgery. For this reason, changes and scarring of the skin or a reduction in the size of the breast are more frequent.
