What Are the Pros and Cons of Using Radiation Therapy for Breast Cancer?

Radiation therapy for breast cancer is a type of radiation therapy for breast cancer.

Radiation therapy for breast cancer

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Radiation therapy for breast cancer is a type of radiation therapy for breast cancer.

Chinese name

Radiation therapy for breast cancer

Subject

Oncology

Radiotherapy for breast cancer is suitable for:

1. After radical or modified radical radiotherapy, the lesions are located in the lateral quadrant and the mass is 5cm. Postoperative pathological examination is not recommended for axillary lymph nodes. Postoperative radiotherapy is not recommended; whether the lesions are located in the median quadrant or central area, and whether radiation is negative The internal breast area is still controversial, but most people do not recommend irradiating the internal breast area; there are 1 to 3 positive axillary lymph nodes, and it is inconclusive whether radiation treatment is required. Positive resection margins or visible residual lesions, T3 and T4 tumors, patients with extracapsular infiltration of lymph nodes, and patients with 4 or more positive lymph nodes, except for regional lymph node radiation therapy, should irradiate the chest wall.

2. Breast-preserving radiotherapy for single lesions of the mammary gland, with a maximum diameter of 4 cm; moderate breast size; no metastasis of the axillary lymph nodes or swollen lymph nodes with a single activity; the patient volunteered.

1. Absolute contraindications for breast-conserving surgery. Two or more primary lumps are not in the same quadrant, accompanied by diffuse microcalcification, multiple metastasis or fusion of axillary lymph nodes, pathological findings of extensive intraductal cancer components, and poor margins. Net person, pregnant patient.

2. Relative contraindications for breast-conserving surgery. The maximum diameter of the tumor is> 4cm. Two or more tumors are located in the same quadrant. The tumor is located in the central area of the breast. The breast volume is too large or too small. Those with a history of vascular collagen diseases.

1. Explain the purpose and effect of the treatment to the patient before the operation, strengthen the confidence to overcome the disease, and explain the precautions to obtain the active cooperation of the patient.

2. Make a full inspection before the whole body is prepared for treatment. Anemia should be corrected, systemic infections should be treated, and comorbidities should be controlled. During the treatment process, let the patients eat high-protein, high-vitamin, high-calorie foods. Improve the patient's overall condition from all aspects, improve the body's immunity, and improve the treatment effect.

3. Local preparation: Keep local skin clean and control infection.

Routine external irradiation

Radiation therapy for breast cancer is divided into radical or modified radical radiotherapy and breast-preserving postoperative radiotherapy. Among them, breast-preserving postoperative radiotherapy is divided into external radiotherapy and implant radiotherapy.

(1) Radioactive source: The irradiation of the lymph drainage area should be mixed with 60Co -rays or high-energy X-rays and electron beams of appropriate energy or only with electron beams. Breast or chest wall tangential irradiation can use high-energy X-rays or 60Co rays, can be irradiated with half beam.

(2) Irradiation range and technique: The patient lies supine on a special bracket for breast radiation therapy. The upper limb of the affected side is fixed and the head is tilted to the healthy side.

Breast tangent irradiation: The breast tangent irradiation is divided into two internal and external tangent fields plus a wedge-shaped plate. The upper boundary is in the second intercostal space (when the clavicle Ueno is set) or the flat sternum notch (when the upper and lower clavicle fields are not set). 1.5 to 2.0 cm below the ditch, the incision boundary can be set at the midline (when the inner milk region is not included) or 3 cm across the midline to the healthy side (when the inner milk region is included), or adjacent to the inner milk field. The external incision is at the level of the axillary midline. The depth of the tangent includes the chest wall at the bottom of the breast and some lung tissues. The depth of the incision is generally within 3 cm, and the height of the tangent field is more than 2 cm above the nipple.

Irradiation of the inner breast area: the inner boundary is at the midline of the sternum, the upper boundary is connected to the lower boundary of the clavicle field, the lower boundary reaches the upper edge of the 4th rib, and the field width is 5cm.

Irradiation of the clavicle in the upper and lower fields: the upper boundary flat ring mesangium, the lower boundary flat second anterior rib, the inner boundary down to the thorax entrance along the midline of the sternocleidomastoid muscle, and the outside at the inner edge of the humeral head. In order to avoid the spinal cord and throat, the angle of the frame is 5 ° to 10 ° when the right side is irradiated; the angle of the frame is 350 ° to 355 ° when the left side is irradiated.

(3) Segmentation method and irradiation dose: For regional lymph node preventive irradiation, 1.8 to 2.0 Gy each time, once a day, 5 times a week, the reference point dose is 50 Gy / 25 to 28 times / 5 to 5.5 weeks. Chest wall irradiation can be irradiated with electron beams of appropriate energy, or tangential irradiation with 60Co -rays or high-energy X-rays. Prevention amount is 50 55Gy / 25 28 times / 5 6 weeks. When the breast is irradiated and the breast is irradiated, the inside and outside tangent fields are taken at the same time, each time 1.8 2.0Gy, once a day, 5 times a week, the mid-plane dose is 45 50Gy / 23 25 times / 5 weeks, and then the field is contracted. The electron beam of appropriate energy is used to irradiate the tumor bed for an additional 10 to 15 Gy.

(4) Design of additional field of tumor bed: It can be positioned by B-ultrasound, CT or MRI, or according to the molybdenum target before operation and the silver clip placed during the operation. For those who do not have the above information, it is recommended to place 3cm outside the incision.

2. Tissue implantation radiotherapy

For those with a positive margin, who refuse to undergo reoperation, or those with deep tumors, 192Ir implantation radiation therapy can be used.

1. There is no need to put fillers on the skin during radiotherapy after breast-conserving surgery in early breast cancer.

2. When the chest wall or breast is irradiated after modified radical mastectomy or locally advanced breast cancer, fillers (half the total amount of radiation) need to be added to the skin.

3. When doing irradiation on the clavicle and breast or chest wall, care should be taken to avoid overlap between the adjacent fields.

4. Radiation complications include skin injury and subcutaneous tissue fibrosis, breast fibrosis, radiation pneumonia, and rib fractures.