For most of this century, the most common treatment available to women with breast cancer was the mastectomy, or surgical removal of the entire breast.

However, a woman today now has other treatment options because of progress made in treating breast cancer over the last twenty years. These advances in treatment offer many more women the chance for cure that was not possible in the past.

Our breast cancer program in Radiation Oncology is part of a multidisciplinary team approach to treating the whole woman, not just the breast cancer. Patients are seen from the beginning by all three oncology specialty teams - Radiation Oncology, Surgical Oncology and Medical Oncology. This approach is critical today for deciding which of the various forms of treatment are best for each patient, and how these treatments need to be coordinated together. Our patients also have access to complimentary services focused specifically for patients with cancer - social workers, nutrition, and physical therapy.

The combination of breast conserving surgery and radiation therapy has been established as a safe and effective alternative to mastectomy for many women. Breast conserving surgery removes the area of cancer in the breast along with a surrounding margin of normal breast tissue. This is then followed by radiation therapy to the remaining breast tissue.

However, breast conservation therapy is not for all women. Even today, a mastectomy may be the recommended treatment for some women. There are advantages and disadvantages with either of these approaches. A patient should discuss these with both their surgeon and radiation oncologist before starting on a course of treatment.

Radiation to the breast after a breast conserving surgery (also called a lumpectomy) takes 6 to 6 ½ weeks. It is given every day, Monday through Friday, with breaks for weekends and major holidays. However, a typical treatment each day will last only 5 - 10 minutes. The entire breast is generally treated for 4 ½ to 5 weeks, followed by a smaller radiation 'boost' to the lumpectomy scar and site where the tumor was originally located for an additional 1 - 1 ½ weeks.

In some cases, women treated by lumpectomy will also need radiation to the lymph node areas of the neck or under the arm.

As many as 25% or more of women who have been treated by a mastectomy will also need radiation. For these women, the chest wall is treated for a total of 5 weeks.

Just as after a lumpectomy, radiation may also be given at the same time to the lymph node areas of the neck or under the arm. The radiation is given externally while a woman is lying on her back on the treatment table. The radiation beams are similar to ordinary chest x-rays or rays from the sun but of much higher energy. The high energy of the radiation causes serious damage to the cancer cells that leads to their destruction. However, normal cells in the breast have a better ability than cancer cells to repair this kind of damage and therefore can survive. This kind of radiation does not make a woman radioactive in any way, so during a course of treatment there is no risk of radiation exposure to family or friends.

Most women tolerate radiation well. Mild fatigue is a common complaint. However, most women can remain fully active during treatment including work, exercise, driving, shopping or other normal activities.

Six weeks or more of daily radiation may be burdensome for some women who live at a great distance from Fox Chase Cancer Center. There is a Fox Chase Network of Radiation Oncology facilities throughout New Jersey and Pennsylvania that may be more convenient for some women. We are proud of the care that we give to our breast cancer patients and highlight several important points about our program:

Experience: We treat approximately 200 breast cancer patients a year in our department of radiation oncology alone.

Radiation for Large Breast Sizes: Historically, these women were often denied breast conserving therapy because of fears about how they would tolerate radiation. We pay particular attention to decrease the side effects of radiation in women with large or pendulous breasts. We routinely use modified higher energy radiation beams that improve the distribution of radiation throughout a large breast. In some women, we prescribe a special support bra during radiation treatment to reduce the peeling or blistering that can occur under underneath the breast. With these measures, women with large breasts are able to better tolerate radiation.

CT Scan Technology: An important clinical advance in our breast program has been three dimensional radiation planning using a dedicated CT scanner in our department. In some women, planning the radiation therapy using CT scans helps the Radiation Oncologist design safer radiation therapy treatment. This may be important in reducing or eliminating the amount of radiation given to lungs or heart. This technology also allows radiation to be given with precision to the place in the breast where the tumor was located. This technology makes the 'boost' treatment more precise than older techniques of using ultrasound or simply the location of the scar on the skin.

When choosing the place for treatment, a woman must often decide based on inadequate information. The most important question a woman should ask is "What are your results". However, most radiation centers will be unable to answer that question. They will quote only national averages, or results from major centers like Fox Chase, because they do not record their own results.

The staff Radiation Oncologists at Fox Chase Cancer Center are active in conducting and publishing clinical research in breast cancer. A partial listing of publications is given below. Within the last few years alone, our staff has addressed the following important clinical research concerns:

Postmastectomy Radiation and Adjuvant Systemic Therapy: Outcomes in high-risk women with stage II-III breast cancer and assessment of clinical, pathologic, and treatment-related factors influencing local-regional control. The Breast Journal 3: 337-344, 1997.

A close or positive margin after mastectomy is not an indication for chest wall irradiation except in women aged fifty or younger. International Journal of Radiation Oncology, Biology and Physics 41: 599-605, 1998. Lung and heart dose volume analyses with CT simulator in radiation treatment of breast cancer. International Journal of Radiation Oncology, Biology and Physics 42: 11-19, 1998.

The presence of proliferative breast disease with atypia does not significantly influence outcome in early-stage invasive breast cancer treated with conservative surgery and radiation. International Journal of Radiation Oncology, Biology and Physics 42: 105-115, 1998.

Patients with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy. International Journal of Radiation Oncology, Biology and Physics 42: 126, 1998.

"Cancer of the Breast". In: Clinical Radiation Oncology: indications, techniques, and results, second edition. Edited by Wang CC. Wiley-Liss, Inc., 2000.

Postmenopausal hormone replacement therapy (HRT): Effect on diagnosis and outcome in early stage invasive breast cancer treated with conservative surgery and radiation. International Journal of Radiation Oncology, Biology and Physics 42: 180, 1998.

Impact of CT simulation for radiation cone down treatment of breast cancer. International Journal of Radiation Oncology, Biology and Physics 42: 244, 1998.

The impact of regional lymphatic irradiation and of the extent of axillary lymph node dissection on regional control in patients with early-stage, node-positive breast cancer, treated with breast conserving therapy. Proc. ASCO 18: 71a; 1999.

Internal mammary node (IMN) irradiation increases dose to the heart and coronary vessels. Int J Radiat Oncol Biol Phys 45: 314; 1999.

Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy. Int J Radiat Oncol Biol Phys 44: 1005-1015; 1999.

Should internal mammary lymph nodes in breast cancer be a target for the radiation oncologist? Int J Radiat Oncol Biol Phys 46: 805-814; 2000.

Internal mammary node irradiation neither decreases distant metastases nor improves survival in stage I and II breast cancer. International Journal of Radiation Oncology, Biology, Physics 47: 883-894; 2000.

Accuracy of the extent of axillary nodal positivity related to primary tumor size, number of involved nodes and number of nodes examined. Int J Radiat Oncol Biol Phys 47: 1177-1183; 2000.

Local Recurrence after mastectomy or breast-conserving surgery and radiation. Oncology 14: 1561-1581; 2000.

Thank you for your interest in the breast cancer program in Radiation Oncology at Fox Chase Cancer Center. New patient consultations with a Radiation Oncologist at Fox Chase Cancer Center can be made by calling Judy Boyd at (215) 728-3815.