Benefits, risks, and safety of external beam radiation therapy for breast cancer

Abstract

Breast cancer is a common and complex disease often necessitating multimodality care. Breast cancer may be treated with surgical resection, radiotherapy (RT), and systemic therapy, including chemotherapy, hormonal therapy, and targeted therapies, or a combination thereof. In the past 50 years, RT has played an increasingly significant role in the treatment of breast cancer, resulting in improvements in locoregional control and survival for women undergoing mastectomy who are at high risk of recurrence, and allowing for breast conservation in certain settings. Although radiation provides significant benefit to many women with breast cancer, it is also associated with risks of toxicity, including cardiac and pulmonary toxicity, lymphedema, and secondary malignancy. RT techniques have advanced and continue to evolve dramatically, offering increased precision and reproducibility of treatment delivery and flexibility of treatment schedule. This increased sophistication of RT offers promise of improved outcomes by maintaining or improving efficacy, reducing toxicity, and increasing patient access and convenience. A review of the role of radiation therapy in breast cancer, its associated toxicities and efforts in toxicity reduction is presented.

Keywords: breast malignancy; outcomes; radiotherapy; toxicity.

Figure 1

Deep inspiration breath hold (DIBH). Notes: Representative axial computed tomography images of a patient undergoing treatment for left-sided breast cancer with (A) free breathing and (B) DIBH techniques. It is apparent that the lung volume has expanded and the heart has moved posteriorly, away from the chest wall.