Radiotherapy for breast cancer

SHORT VERSION

In France, breast cancer affects nearly 50,000 women per year. This cancer is usually diagnosed early thanks to the screening campaigns that have been put in place. The choice among the many available treatments (surgery, radiotherapy, chemotherapy, hormone therapy) is based on the tumor type and the patient’s characteristics (e.g. age).

In France, breast cancer affects nearly 50,000 women per year. Today, breast cancer is diagnosed earlier than before thanks to the screening campaigns that have been put in place.

 

Currently, different treatments (surgery, radiation therapy, chemotherapy, and hormone therapy) are available for breast cancer management. The choice of  treatment(s) and their sequence is based on the tumor type and size and on other clinical parameters, such as the patient’s age and health status. The goal of these treatments is to destroy all cancer cells and prevent the risk of tumor recurrence in the affected breast (in patients who had breast-conserving surgery), in the other breast, or at distance (metastases).

 

For breast cancer, radiotherapy can be used to treat different areas, mostly after surgery:

  • the breast gland (after breast-conserving surgery)
  • the tumor bed (the breast area where the tumor was located before breast-conserving surgery, to deliver a higher dose of radiotherapy than in the rest of the breast, called “boost”)
  • the chest wall (sometimes irradiated after total mastectomy in patients with negative prognostic factors)
  • the internal mammary chain, the supra- and sub-clavicular, and the axillary lymph nodes.

 

Breast cancer management has three components:

  • locoregional treatment, which often combines surgery and radiotherapy;
  • systemic treatment (which affects the whole body) by chemotherapy to eradicate micro-metastases that are not visible on imaging;
  • systemic treatment by hormone therapy (for hormone-dependent tumors) to limit the risk of recurrence.

 

Surgery for breast cancer can be radical (mastectomy) or conservative. In radical surgical therapy (mastectomy), the entire breast is removed, whereas in conservative surgery only  the tumor is removed (lumpectomy). In the case of mastectomy, the patient may choose to undergo breast reconstruction during or after the tumor surgery.

 

Radiotherapy is almost always prescribed after breast-conserving surgery to limit the risk of tumor recurrence in the breast. This is not the case after mastectomy.